Provider Demographics
NPI:1730763392
Name:STACY, CORY ELIZABETH
Entity type:Individual
Prefix:
First Name:CORY
Middle Name:ELIZABETH
Last Name:STACY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CORY
Other - Middle Name:ELIZABETH
Other - Last Name:STEPHENS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:808 S PEORIA AVE
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74120-4427
Mailing Address - Country:US
Mailing Address - Phone:918-508-9676
Mailing Address - Fax:
Practice Address - Street 1:1055 S HOUSTON AVE
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74127-9043
Practice Address - Country:US
Practice Address - Phone:918-508-9676
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-10
Last Update Date:2024-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator