Provider Demographics
NPI:1679371983
Name:HOMAN, STACIA KAYLEE (APRN, PNP-PC)
Entity type:Individual
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First Name:STACIA
Middle Name:KAYLEE
Last Name:HOMAN
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Gender:F
Credentials:APRN, PNP-PC
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Mailing Address - Street 1:3001 QUAIL SPRINGS PKWY FL 5
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73134-2640
Mailing Address - Country:US
Mailing Address - Phone:918-786-9009
Mailing Address - Fax:918-786-3724
Practice Address - Street 1:601 E 13TH ST
Practice Address - Street 2:
Practice Address - City:GROVE
Practice Address - State:OK
Practice Address - Zip Code:74344-2989
Practice Address - Country:US
Practice Address - Phone:918-786-9009
Practice Address - Fax:918-786-3724
Is Sole Proprietor?:No
Enumeration Date:2025-03-04
Last Update Date:2025-06-18
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OK222271363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics