Provider Demographics
NPI:1679371983
Name:HOMAN, STACIA KAYLEE (APRN, PNP-PC)
Entity type:Individual
Prefix:
First Name:STACIA
Middle Name:KAYLEE
Last Name:HOMAN
Suffix:
Gender:
Credentials:APRN, PNP-PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6026 LAKE BREEZE RD
Mailing Address - Street 2:
Mailing Address - City:GROVE
Mailing Address - State:OK
Mailing Address - Zip Code:74344-7896
Mailing Address - Country:US
Mailing Address - Phone:417-439-9911
Mailing Address - Fax:
Practice Address - Street 1:601 E 13TH ST
Practice Address - Street 2:
Practice Address - City:GROVE
Practice Address - State:OK
Practice Address - Zip Code:74344-2989
Practice Address - Country:US
Practice Address - Phone:918-786-9900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-04
Last Update Date:2025-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK222271208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics