Provider Demographics
NPI:1104826569
Name:KNAPP, STACEY D (DO)
Entity type:Individual
Prefix:
First Name:STACEY
Middle Name:D
Last Name:KNAPP
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:STACEY
Other - Middle Name:D
Other - Last Name:HALE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5300 N INDEPENDENCE AVE STE 280
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-5555
Mailing Address - Country:US
Mailing Address - Phone:405-945-4587
Mailing Address - Fax:405-713-2735
Practice Address - Street 1:3500 NW 56TH ST # SREET100
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112
Practice Address - Country:US
Practice Address - Phone:405-951-2855
Practice Address - Fax:405-951-2858
Is Sole Proprietor?:No
Enumeration Date:2005-07-28
Last Update Date:2018-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3962207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200035270AMedicaid
OK249426601Medicare PIN
OK200035270AMedicaid