Provider Demographics
NPI:1427338102
Name:ROSEKELLY, STEPHANIE M (CNM, APN)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:M
Last Name:ROSEKELLY
Suffix:
Gender:F
Credentials:CNM, APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4086 COUNTRY CLUB RD STE 2
Mailing Address - Street 2:
Mailing Address - City:DUNCAN
Mailing Address - State:OK
Mailing Address - Zip Code:73533-5580
Mailing Address - Country:US
Mailing Address - Phone:847-989-9124
Mailing Address - Fax:214-617-0352
Practice Address - Street 1:4086 COUNTRY CLUB RD STE 2
Practice Address - Street 2:
Practice Address - City:DUNCAN
Practice Address - State:OK
Practice Address - Zip Code:73533-5580
Practice Address - Country:US
Practice Address - Phone:580-609-0105
Practice Address - Fax:214-617-0352
Is Sole Proprietor?:No
Enumeration Date:2011-08-25
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKR0135299367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife