Provider Demographics
NPI:1770572091
Name:SPEARS, STACY (ARNP)
Entity type:Individual
Prefix:
First Name:STACY
Middle Name:
Last Name:SPEARS
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:STACY
Other - Middle Name:SPEARS
Other - Last Name:AHMED
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:23 E ROSS AVE
Mailing Address - Street 2:
Mailing Address - City:SAPULPA
Mailing Address - State:OK
Mailing Address - Zip Code:74066-6423
Mailing Address - Country:US
Mailing Address - Phone:918-227-2016
Mailing Address - Fax:918-227-1125
Practice Address - Street 1:23 E ROSS AVE
Practice Address - Street 2:
Practice Address - City:SAPULPA
Practice Address - State:OK
Practice Address - Zip Code:74066-6423
Practice Address - Country:US
Practice Address - Phone:918-227-2016
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-19
Last Update Date:2024-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKR0059224363LP0808X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200045970AMedicaid
OK200045970AMedicaid
Q50526Medicare UPIN