Provider Demographics
NPI:1881859353
Name:STOCKERT, KASSI (MD)
Entity Type:Individual
Prefix:
First Name:KASSI
Middle Name:
Last Name:STOCKERT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:909 26TH AVE NW
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73069-6366
Mailing Address - Country:US
Mailing Address - Phone:405-801-2323
Mailing Address - Fax:405-801-2366
Practice Address - Street 1:909 26TH AVE NW
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73069-6366
Practice Address - Country:US
Practice Address - Phone:405-801-2323
Practice Address - Fax:405-801-2366
Is Sole Proprietor?:No
Enumeration Date:2008-07-24
Last Update Date:2023-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK26361207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARE-13758OtherSTATE LICENSE
OK26361OtherSTATE LICENSE