Provider Demographics
NPI:1366831455
Name:PORTER, STEPHANIE (PA)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:PORTER
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:1016 24TH AVE NW STE 110
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73069-6542
Mailing Address - Country:US
Mailing Address - Phone:405-467-2280
Mailing Address - Fax:405-335-6941
Practice Address - Street 1:1016 24TH AVE NW STE 110
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73069-6542
Practice Address - Country:US
Practice Address - Phone:405-467-2280
Practice Address - Fax:405-335-6941
Is Sole Proprietor?:No
Enumeration Date:2015-01-13
Last Update Date:2025-09-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OK2480363A00000X
363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant