Provider Demographics
NPI:1740048875
Name:STEVENSON, JORJA (APRN-BC, PMHNP-BC)
Entity type:Individual
Prefix:
First Name:JORJA
Middle Name:
Last Name:STEVENSON
Suffix:
Gender:
Credentials:APRN-BC, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2249 NW 197TH ST
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73012-5201
Mailing Address - Country:US
Mailing Address - Phone:918-223-6196
Mailing Address - Fax:
Practice Address - Street 1:1220 N MAIN ST STE 4
Practice Address - Street 2:
Practice Address - City:NEWCASTLE
Practice Address - State:OK
Practice Address - Zip Code:73065-4175
Practice Address - Country:US
Practice Address - Phone:405-703-9942
Practice Address - Fax:405-703-9942
Is Sole Proprietor?:No
Enumeration Date:2024-03-12
Last Update Date:2025-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK222307363LP0808X
OKR0135013163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse