Provider Demographics
NPI:1780989772
Name:STEPHENSON, KELLI DEAN (FNP-C)
Entity type:Individual
Prefix:
First Name:KELLI
Middle Name:DEAN
Last Name:STEPHENSON
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:KELLI
Other - Middle Name:DEAN
Other - Last Name:BANKS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 13620
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73113-1629
Mailing Address - Country:US
Mailing Address - Phone:405-445-1210
Mailing Address - Fax:405-445-3310
Practice Address - Street 1:2518 N MAIN ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:OK
Practice Address - Zip Code:74354-1602
Practice Address - Country:US
Practice Address - Phone:918-540-9077
Practice Address - Fax:918-540-9080
Is Sole Proprietor?:No
Enumeration Date:2011-01-21
Last Update Date:2025-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN33371363L00000X, 367A00000X
OR201394741NP-PP363LF0000X
WAAP60494710363LF0000X
OR201800264NP-PP363LX0001X, 367A00000X
OK225099363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
No367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife