Provider Demographics
NPI:1073199790
Name:GOSS, STEVIE RAE (RN)
Entity Type:Individual
Prefix:MRS
First Name:STEVIE
Middle Name:RAE
Last Name:GOSS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:STEVIE
Other - Middle Name:RAE
Other - Last Name:NEWELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:403 E EXCELSIOR
Mailing Address - Street 2:
Mailing Address - City:VINITA
Mailing Address - State:OK
Mailing Address - Zip Code:74301
Mailing Address - Country:US
Mailing Address - Phone:918-256-6476
Mailing Address - Fax:
Practice Address - Street 1:403 E EXCELSIOR
Practice Address - Street 2:
Practice Address - City:VINITA
Practice Address - State:OK
Practice Address - Zip Code:74301
Practice Address - Country:US
Practice Address - Phone:918-256-6476
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-23
Last Update Date:2021-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK136079163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse