Provider Demographics
NPI:1013729490
Name:STONER, ALLY NICOLE (OTS)
Entity type:Individual
Prefix:
First Name:ALLY
Middle Name:NICOLE
Last Name:STONER
Suffix:
Gender:F
Credentials:OTS
Other - Prefix:
Other - First Name:ALLY
Other - Middle Name:NICOLE
Other - Last Name:ISHAM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OTS
Mailing Address - Street 1:12522 S 102ND EAST AVE
Mailing Address - Street 2:
Mailing Address - City:BIXBY
Mailing Address - State:OK
Mailing Address - Zip Code:74008-3041
Mailing Address - Country:US
Mailing Address - Phone:918-810-4470
Mailing Address - Fax:
Practice Address - Street 1:7006 CHAD COLLEY BLVD
Practice Address - Street 2:
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72916-6024
Practice Address - Country:US
Practice Address - Phone:479-401-6013
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-23
Last Update Date:2025-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program