Provider Demographics
NPI:1023765500
Name:STEPHENS, TRELYNN (LPN)
Entity type:Individual
Prefix:
First Name:TRELYNN
Middle Name:
Last Name:STEPHENS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:829 ELM CREEK DR
Mailing Address - Street 2:
Mailing Address - City:MOORE
Mailing Address - State:OK
Mailing Address - Zip Code:73160-0915
Mailing Address - Country:US
Mailing Address - Phone:405-506-5590
Mailing Address - Fax:
Practice Address - Street 1:829 ELM CREEK DR
Practice Address - Street 2:
Practice Address - City:MOORE
Practice Address - State:OK
Practice Address - Zip Code:73160-0915
Practice Address - Country:US
Practice Address - Phone:405-506-5590
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-04
Last Update Date:2022-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK205445164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes164W00000XNursing Service ProvidersLicensed Practical NurseGroup - Single Specialty