Individual
STACY DANIELLE PROVENCE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
6800 NW 39TH EXPY, BETHANY, OK 73008-2513
(405) 789-6711
(405) 440-6716
Mailing address
6800 NW 39TH EXPY, BETHANY, OK 73008-2513
(405) 789-6711
(405) 440-6716
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
0089753
OK
Other
Enumeration date
09/23/2015
Last updated
11/14/2019
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