Provider Demographics
NPI:1417412362
Name:JUSTUS, STEPHANIE (APRN-CNP, FNP-C)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:JUSTUS
Suffix:
Gender:F
Credentials:APRN-CNP, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1124 W WILL ROGERS BLVD
Mailing Address - Street 2:
Mailing Address - City:CLAREMORE
Mailing Address - State:OK
Mailing Address - Zip Code:74017-5421
Mailing Address - Country:US
Mailing Address - Phone:918-322-7400
Mailing Address - Fax:918-322-7600
Practice Address - Street 1:1124 W WILL ROGERS BLVD
Practice Address - Street 2:
Practice Address - City:CLAREMORE
Practice Address - State:OK
Practice Address - Zip Code:74017-5421
Practice Address - Country:US
Practice Address - Phone:918-322-7400
Practice Address - Fax:918-322-7600
Is Sole Proprietor?:No
Enumeration Date:2019-02-05
Last Update Date:2022-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKR0132543363LF0000X
OK1982722195207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily