1740048875 NPI number — JORJA STEVENSON APRN-BC, PMHNP-BC

Table of content: JORJA STEVENSON APRN-BC, PMHNP-BC (NPI 1740048875)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1740048875 NPI number — JORJA STEVENSON APRN-BC, PMHNP-BC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
STEVENSON
Provider First Name:
JORJA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
APRN-BC, PMHNP-BC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1740048875
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/03/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2249 NW 197TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EDMOND
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
73012-5201
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
918-223-6196
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1220 N MAIN ST STE 4
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEWCASTLE
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
73065-4175
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
405-703-9942
Provider Business Practice Location Address Fax Number:
405-703-9942
Provider Enumeration Date:
03/12/2024

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LP0808X , with the licence number:  222307 , registered in the state of OK ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 163W00000X , with the licence number: R0135013 , registered in the state of OK ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com