Individual
MS. STACY LOUISE FAGAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.A.
Contact information
Practice address
2512 N MERIDIAN AVE, OKLAHOMA CITY, OK 73107-1035
(405) 605-5415
(405) 605-5310
Mailing address
2512 N MERIDIAN AVE, OKLAHOMA CITY, OK 73107-1035
(405) 605-5415
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
1779
OK
Other
Enumeration date
11/13/2008
Last updated
02/09/2011
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