Provider Demographics
NPI:1417153776
Name:STEVENSON, PATRICIA ANN JUSTICE (APRN)
Entity Type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:ANN JUSTICE
Last Name:STEVENSON
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:MS
Other - First Name:PATRICIA
Other - Middle Name:ANN
Other - Last Name:JUSTICE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:11770 RODEO DR
Mailing Address - Street 2:
Mailing Address - City:SKIATOOK
Mailing Address - State:OK
Mailing Address - Zip Code:74070-5804
Mailing Address - Country:US
Mailing Address - Phone:405-473-2123
Mailing Address - Fax:
Practice Address - Street 1:11770 RODEO DR
Practice Address - Street 2:
Practice Address - City:SKIATOOK
Practice Address - State:OK
Practice Address - Zip Code:74070-5804
Practice Address - Country:US
Practice Address - Phone:405-473-2123
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-25
Last Update Date:2016-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK43974163W00000X
OK2017163WW0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WW0000XNursing Service ProvidersRegistered NurseWound Care