Individual provider · Type 1 NPI
Stacy Danielle Provence
Pediatric Nurse Practitioner · Bethany, OK
NPI number
1912376765
Active
Practice location
6800 NW 39th Expy
Bethany, OK 73008-2513
Fax (405) 440-6716
Specialties and licenses
| Taxonomy | Code | License |
|---|---|---|
| Pediatric Nurse Practitioner Primary | 363LP0200X | 0089753 (OK) |
Pediatric Nurse Practitioner: Definition to come...
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About NPI 1912376765
Stacy Danielle Provence's National Provider Identifier is 1912376765, issued on Sep 23, 2015. The primary taxonomy on file is Pediatric Nurse Practitioner (363LP0200X), and the practice location is in Bethany, OK. The record was last updated on Nov 14, 2019.