Provider Demographics
NPI:1447376223
Name:NOLAND, STACY LYNN (DO)
Entity type:Individual
Prefix:DR
First Name:STACY
Middle Name:LYNN
Last Name:NOLAND
Suffix:
Gender:F
Credentials:DO
Other - Prefix:MISS
Other - First Name:STACY
Other - Middle Name:LYNN
Other - Last Name:NELSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9001 S 101ST EAST AVE
Mailing Address - Street 2:SUITE 350
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74133-5708
Mailing Address - Country:US
Mailing Address - Phone:918-293-6200
Mailing Address - Fax:918-293-6246
Practice Address - Street 1:9001 S 101ST EAST AVE
Practice Address - Street 2:SUITE 350
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74133-5708
Practice Address - Country:US
Practice Address - Phone:918-293-6200
Practice Address - Fax:918-293-6246
Is Sole Proprietor?:No
Enumeration Date:2007-03-22
Last Update Date:2013-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4219207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK1447376223OtherNPI