Provider Demographics
NPI:1902143183
Name:TIMMONS, STACEY ANN (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:STACEY
Middle Name:ANN
Last Name:TIMMONS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MISS
Other - First Name:STACEY
Other - Middle Name:ANN
Other - Last Name:HEARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2017 W I 35 FRONTAGE RD
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73013-8504
Mailing Address - Country:US
Mailing Address - Phone:405-509-2800
Mailing Address - Fax:405-509-2885
Practice Address - Street 1:2017 W I 35 FRONTAGE RD
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73013-8504
Practice Address - Country:US
Practice Address - Phone:405-509-2800
Practice Address - Fax:405-509-2885
Is Sole Proprietor?:No
Enumeration Date:2013-01-08
Last Update Date:2022-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2187363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant