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Stacy Danielle Provence

Nurse Practitioner - Pediatrics β€’ Bethany, OK

Active NPI 1912376765 Individual Practitioner Female Practitioner
Practice location in NPPES

6800 Nw 39th Expy
Bethany, OK 730082513

Call 4057896711 Location details and other listings
Medical Disclaimer

This profile restates public CMS/NPPES data; T-MedInfo gives no medical advice — consult a licensed professional, and call 911 for emergencies.

Practice Location & Contact Primary Location

Practice Address

6800 Nw 39th Expy

Bethany, OK 730082513

Telephone 4057896711
Fax 4054406716
Organization at the Same NPPES Address or Phone
The Children's Center, Inc. Facility NPI 1740395409

Matched by practice address or phone in NPPES. A shared address or phone does not confirm that this clinician works there.

Industry payments (Open Payments)

No Open Payments records are listed for this clinician for 2021–2025.

Guide: How to read an Open Payments record

NPI first issued

2015

The year this clinician's National Provider Identifier (NPI) was issued. An NPI is a unique 10-digit ID that US health care providers use for billing.

What this does not show: NPI first issued

NPIs have been issued only since 2005, so this year is not necessarily when the clinician started practicing.

Source: CMS NPPES NPI Registry.

Medicare assignment not listed

CMS data do not show whether this clinician accepts Medicare assignment. This does not mean they do not accept Medicare. Ask the office.

Medicare assignment applies to Original Medicare. It does not tell you whether the clinician is in a Medicare Advantage plan's network, accepts other insurance, or is taking new patients.

Source: CMS Doctors and Clinicians; Medicare.gov, β€œDoes your provider accept Medicare as full payment?”

Guide: What Medicare assignment means

No telehealth indicator

CMS shows this indicator only when recent Medicare claims include telehealth services. The clinician may still offer telehealth; ask the office.

Source: CMS, Telehealth Indicator on Medicare Care Compare (fact sheet, January 2023); CMS Doctors and Clinicians.

Guide: How Medicare covers telehealth

Compared with the same specialty in Bethany and Oklahoma

3 active clinicians are listed under Nurse Practitioner - Pediatrics with a practice address in Bethany, OK (178 in Oklahoma).

Addresses are self-reported to NPPES and may be out of date.

Sources: CMS Doctors and Clinicians, CMS NPPES NPI Registry. Specialty names follow the NUCC Health Care Provider Taxonomy.

Text: T-MedInfo Β· Report an error.

Specialties & License Numbers Reported to NPPES

Nurse Practitioner - Pediatrics Primary Specialty

NUCC Taxonomy Code: 363LP0200X

License # reported to NPPES OK 0089753
Check License Status with the State Board License numbers are self-reported to NPPES; T-MedInfo does not confirm them against state records. Current status: Oklahoma State Board of Medical Licensure.
Look Up on State Board Site

Clinicians Sharing This Practice Address or Phone

Clinicians sharing this NPPES address, phone or fax; a shared contact does not mean they work together.

9 listed
Matthew Bross , PA-C

Physician Assistant

NPI 1003582842

Physician Assistant (Certified)

Dr. Jordan Ferris , DPT

Physical Therapist

NPI 1851984819

Doctor of Physical Therapy

Dr. Kodi Hainey , DPT

Physical Therapist

NPI 1699488304

Doctor of Physical Therapy

Dr. Chelsie Hollas , MD, MPH

Medical Genetics - Clinical Genetics (M.D.)

NPI 1427677145

Doctor of Medicine (M.D.), Master of Public Health

NPI 1932177243

Doctor of Medicine (M.D.)

Leianna Lamar , CNP

Nurse Practitioner - Family

NPI 1538525837

Certified Nurse Practitioner

Career & Practice History Timeline

Changes recorded in monthly NPPES data files: addresses, names, credentials, specialties and NPI status

7 Historical Events
πŸ‘€
Provider Name / Credentials Updated November 14, 2019

Recorded as STACY PROVENCE

βœ…
NPI Profile Active January 27, 2016

NPI status registered as active in NPPES database

πŸ“
Practice Location (Initial Record) January 27, 2016

Registered at 6800 NW 39TH EXPY, BETHANY, OK 730082513 (Tel: 4057896711)

πŸ“
Business Mailing Address (Initial Record) January 27, 2016

Registered at 6800 NW 39TH EXPY, BETHANY, OK 730082513 (Tel: 4057896711)

πŸ‘€
Provider Name / Credentials (Initial Record) January 27, 2016

Recorded as STACY NELSON

πŸŽ“
Medical Taxonomy / Specialty Registered (Primary Specialty) January 27, 2016

Nurse Practitioner (license number reported to NPPES: OK 0089753)

🟒
Initial NPI Registration & Enumeration September 23, 2015

First registered as active Individual Practitioner in NPPES Database.

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NPI Administrative Meta

NPI Number: 1912376765
Entity Type:
Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)
Enumeration Date: September 23, 2015
Last Update: November 14, 2019
Sole Proprietor: No

Mailing Address

6800 Nw 39th Expy

Bethany, OK 730082513

Phone: 4057896711

About This Data NPPES fields (address, phone, specialty, license) are self-reported and may be outdated; Medicare fields follow the CMS dataset named in each section. Correct directly at NPPES.