Provider Demographics
NPI:1316178262
Name:MOWDY, STEPHANIE RANAE (APRN,MS,CCNS)
Entity Type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:RANAE
Last Name:MOWDY
Suffix:
Gender:F
Credentials:APRN,MS,CCNS
Other - Prefix:PROF
Other - First Name:STEPHANIE
Other - Middle Name:RANAE
Other - Last Name:MOWDY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:APRN,MS,CCNS
Mailing Address - Street 1:527 W 3RD ST
Mailing Address - Street 2:
Mailing Address - City:KONAWA
Mailing Address - State:OK
Mailing Address - Zip Code:74849-1415
Mailing Address - Country:US
Mailing Address - Phone:580-925-3286
Mailing Address - Fax:580-925-9149
Practice Address - Street 1:905 COLONY DR
Practice Address - Street 2:
Practice Address - City:ADA
Practice Address - State:OK
Practice Address - Zip Code:74820-2329
Practice Address - Country:US
Practice Address - Phone:580-436-5111
Practice Address - Fax:580-436-1159
Is Sole Proprietor?:No
Enumeration Date:2009-07-27
Last Update Date:2021-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKR47989163WD0400X, 163WE0900X, 163WW0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WW0000XNursing Service ProvidersRegistered NurseWound Care
No163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator
No163WE0900XNursing Service ProvidersRegistered NurseEnterostomal Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK47989OtherOKLAHOMA BOARD OF NURSING