Provider Demographics
NPI:1760225940
Name:STEVENS, TRISHA DAWN
Entity type:Individual
Prefix:MS
First Name:TRISHA
Middle Name:DAWN
Last Name:STEVENS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1558 N 1ST ST
Mailing Address - Street 2:
Mailing Address - City:HARRAH
Mailing Address - State:OK
Mailing Address - Zip Code:73045-9708
Mailing Address - Country:US
Mailing Address - Phone:405-468-0851
Mailing Address - Fax:
Practice Address - Street 1:1558 N 1ST ST
Practice Address - Street 2:
Practice Address - City:HARRAH
Practice Address - State:OK
Practice Address - Zip Code:73045-9708
Practice Address - Country:US
Practice Address - Phone:405-915-4204
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-17
Last Update Date:2024-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist