Stacey, Kendra K

Stacey, Kendra K is an individual health care provider with primary practice located at 102 Nw 31St , Lawton OK 73505. She recently has 2 registered licenses in different health care specialties including Physician Assistants & Advanced Practice Nursing Providers / Family, Physician Assistants & Advanced Practice Nursing Providers / Obstetrics & Gynecology. Physician Assistants & Advanced Practice Nursing Providers / Family is her primary health care specialty. Stacey, Kendra K can be contacted via phone (580) 353-6790.

Contact Information

Primary practice address
102 Nw 31St Lawton OK 73505
Phone: (580) 353-6790
Fax: (580) 510-7019
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Family 363LF0000X R0052337 Oklahoma
Physician Assistants & Advanced Practice Nursing Providers / Obstetrics & Gynecology 363LX0001X R0052337 Oklahoma

Profile Details

NPI number 1124014790
LBN Legal business name Stacey, Kendra K
Credentials ARNP
Entity Individual
Sole proprietor 1 No
Enumeration date Sep 20th, 2005
Last updated Feb 12th, 2008 - about 18 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1124014790 NPPES
Oklahoma Other 7591256 AETNA
Oklahoma Other 628427054001 AETNA

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