Provider Demographics
NPI:1407638513
Name:JUDD, STEPHANE LYNN
Entity type:Individual
Prefix:
First Name:STEPHANE
Middle Name:LYNN
Last Name:JUDD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:STEPHANE
Other - Middle Name:LYNN
Other - Last Name:ORSINI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 236
Mailing Address - Street 2:
Mailing Address - City:WETUMKA
Mailing Address - State:OK
Mailing Address - Zip Code:74883-0236
Mailing Address - Country:US
Mailing Address - Phone:405-452-5400
Mailing Address - Fax:405-452-3000
Practice Address - Street 1:109 S MAIN ST
Practice Address - Street 2:
Practice Address - City:WETUMKA
Practice Address - State:OK
Practice Address - Zip Code:74883-4015
Practice Address - Country:US
Practice Address - Phone:405-452-5400
Practice Address - Fax:405-452-3000
Is Sole Proprietor?:No
Enumeration Date:2023-10-16
Last Update Date:2024-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK219036363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner