Individual
JOHN LEVI STANFORD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PMHNP-BC
Contact information
Practice address
9228 S MINGO RD STE 101&103, TULSA, OK 74133-5718
(918) 221-0877
Mailing address
9228 S MINGO RD STE 101&103, TULSA, OK 74133-5718
(918) 221-0877
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
R0131069
OK
163WA0400X
Addiction (Substance Use Disorder) Registered Nurse
R0131069
OK
163WP0808X
Psychiatric/Mental Health Registered Nurse
R0131069
OK
163WP0809X
Adult Psychiatric/Mental Health Registered Nurse
R0131069
OK
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
210536
OK
Other
Enumeration date
02/09/2021
Last updated
10/13/2022
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