Provider Demographics
NPI:1053644716
Name:EDWARDS, STEFFANEE RENEE (NP)
Entity Type:Individual
Prefix:MRS
First Name:STEFFANEE
Middle Name:RENEE
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:STEFFANEE
Other - Middle Name:RENEE
Other - Last Name:STOCKTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 236
Mailing Address - Street 2:
Mailing Address - City:WETUMKA
Mailing Address - State:OK
Mailing Address - Zip Code:74883-0236
Mailing Address - Country:US
Mailing Address - Phone:405-452-5400
Mailing Address - Fax:405-452-3000
Practice Address - Street 1:109 S MAIN ST
Practice Address - Street 2:
Practice Address - City:WETUMKA
Practice Address - State:OK
Practice Address - Zip Code:74883-4015
Practice Address - Country:US
Practice Address - Phone:405-452-5400
Practice Address - Fax:405-452-3000
Is Sole Proprietor?:No
Enumeration Date:2009-09-14
Last Update Date:2021-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK57663363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK2002616020AMedicaid
OK2002616020AMedicaid