Provider Demographics
NPI:1376110205
Name:STEPHENSON, KARI LYNNE
Entity type:Individual
Prefix:
First Name:KARI
Middle Name:LYNNE
Last Name:STEPHENSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2106 W FERGUSON AVE
Mailing Address - Street 2:
Mailing Address - City:BLACKWELL
Mailing Address - State:OK
Mailing Address - Zip Code:74631-5426
Mailing Address - Country:US
Mailing Address - Phone:580-352-8012
Mailing Address - Fax:
Practice Address - Street 1:2106 W FERGUSON AVE
Practice Address - Street 2:
Practice Address - City:BLACKWELL
Practice Address - State:OK
Practice Address - Zip Code:74631-5426
Practice Address - Country:US
Practice Address - Phone:580-352-8012
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-09
Last Update Date:2021-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator