Provider Demographics
NPI:1447382684
Name:MCCALMAN, STEPHANIE JO (PAC)
Entity Type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:JO
Last Name:MCCALMAN
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:MS
Other - First Name:STEPHANIE
Other - Middle Name:JO
Other - Last Name:SCAGNELLI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PAC
Mailing Address - Street 1:1705 E 19TH ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74104-5404
Mailing Address - Country:US
Mailing Address - Phone:918-744-3180
Mailing Address - Fax:918-744-3187
Practice Address - Street 1:1705 E 19TH ST
Practice Address - Street 2:SUITE 201
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74104-5404
Practice Address - Country:US
Practice Address - Phone:918-744-3180
Practice Address - Fax:918-744-3187
Is Sole Proprietor?:No
Enumeration Date:2007-03-12
Last Update Date:2008-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1592363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200115030AMedicaid
OK242713901Medicare PIN
OK200115030AMedicaid