Basic Information
| Provider Information | |||||||||
| NPI: | 1316178262 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MOWDY | ||||||||
| FirstName: | STEPHANIE | ||||||||
| MiddleName: | RANAE | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | APRN,MS,CCNS | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | MOWDY | ||||||||
| OtherFirstName: | STEPHANIE | ||||||||
| OtherMiddleName: | RANAE | ||||||||
| OtherNamePrefix: | PROF. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | APRN,MS,CCNS | ||||||||
| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 527 W 3RD ST | ||||||||
| Address2: | |||||||||
| City: | KONAWA | ||||||||
| State: | OK | ||||||||
| PostalCode: | 748491415 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5809253286 | ||||||||
| FaxNumber: | 5809259149 | ||||||||
| Practice Location | |||||||||
| Address1: | 905 COLONY DR | ||||||||
| Address2: | |||||||||
| City: | ADA | ||||||||
| State: | OK | ||||||||
| PostalCode: | 748202329 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5804365111 | ||||||||
| FaxNumber: | 5804361159 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/27/2009 | ||||||||
| LastUpdateDate: | 11/22/2021 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | |||||||||
| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 11/22/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WD0400X | R47989 | OK | N | Nursing Service Providers | Registered Nurse | Diabetes Educator | 163WE0900X | R47989 | OK | N | Nursing Service Providers | Registered Nurse | Enterostomal Therapy | 163WW0000X | R47989 | OK | Y | Nursing Service Providers | Registered Nurse | Wound Care |
ID Information
| ID | Type | State | Issuer | Description | 47989 | 01 | OK | OKLAHOMA BOARD OF NURSING | OTHER |