Provider Demographics
NPI:1003878612
Name:WHATLEY, STEPHANIE ARLENE (PA)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:ARLENE
Last Name:WHATLEY
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5300 N INDEPENDENCE AVE
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-5556
Mailing Address - Country:US
Mailing Address - Phone:580-213-9794
Mailing Address - Fax:580-213-9795
Practice Address - Street 1:2821 N VAN BUREN ST STE B
Practice Address - Street 2:
Practice Address - City:ENID
Practice Address - State:OK
Practice Address - Zip Code:73703-1729
Practice Address - Country:US
Practice Address - Phone:580-213-9794
Practice Address - Fax:580-213-9795
Is Sole Proprietor?:No
Enumeration Date:2006-04-06
Last Update Date:2018-02-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OK1136363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKP01318927OtherRR MEDICARE
OK200004000AMedicaid
OKP53023Medicare UPIN
OK200004000AMedicaid