Provider Demographics
NPI:1861699738
Name:STANTON, AUDREY MELISSA (DO)
Entity type:Individual
Prefix:DR
First Name:AUDREY
Middle Name:MELISSA
Last Name:STANTON
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1923 S UTICA AVE
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74104-6520
Mailing Address - Country:US
Mailing Address - Phone:918-744-2288
Mailing Address - Fax:918-744-2948
Practice Address - Street 1:12451 E 100TH ST N
Practice Address - Street 2:EMERGENCY DEPT
Practice Address - City:OWASSO
Practice Address - State:OK
Practice Address - Zip Code:74055-4600
Practice Address - Country:US
Practice Address - Phone:918-274-5000
Practice Address - Fax:918-274-5919
Is Sole Proprietor?:No
Enumeration Date:2007-07-02
Last Update Date:2014-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4561207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200183040AMedicaid
OK200183040AMedicaid
OKOKA100304Medicare PIN