NPIMap

Individual provider Active NPI

Manda Lea Stephens, APRN, CNP

  • Adult Health Nurse Practitioner
  • Altus, OK
National Provider Identifier
1831471101
Registry record updated Oct 30, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Health Nurse PractitionerTaxonomy code 363LA2200X
License
66290 Issued in OK
Practice address
205 S Park LN
Altus, OK 73521-5755
Phone
(580) 379-6710
Fax
(580) 379-6714
NPI assigned
Sep 13, 2011
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 30, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Health Nurse Practitioner 363LA2200X 66290 OK Primary
Nurse Practitioner 363L00000X 66290 OK

Addresses

Primary practice location

205 S Park LN
Altus, OK 73521-5755

Mailing address

1200 E Pecan St
Altus, OK 73521-6141
Phone (580) 379-5000

Other identifiers 1

IdentifierTypeStateIssuer
200388530AMedicaidOK

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address MandaStephens@direct.jcmh.com

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OK
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20111227000311 OK Practitioner - Nurse Practitioner 3274706726 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
University of Oklahoma College of Medicine, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Jackson County Memorial Hospital Authority 46 clinicians

Practice addresses (Care Compare)

1200 E Pecan St
Altus, OK 73521-6141

205 S Park LN
Suite 210
Altus, OK 73521-5757
Phone (580) 379-6650

Hospital & facility affiliations

  • Angels Care Home Health of Oklahoma Home health agency, Oklahoma City, OK, CCN 377447
  • Jackson County Memorial Hospital Authority Home health agency, Altus, OK, CCN 377137
  • Jackson County Memorial Hospital Authority Hospital, Altus, OK, CCN 370022

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Certified Nurse Practitioner, Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Shortgrass Community Health Center, Inc CurrentSince Jun 1, 2021 Accepting new patients
Shortgrass Community Health Center, Inc CurrentSince Jun 1, 2021 Accepting new patients
Jackson County Memorial Hosp Phcy Past Accepting new patients
Jackson County Memorial Hospital Authority Past Accepting new patients

Locations

101 S Hudson St
Altus, OK 73521
Phone (580) 301-6154

400 E Sycamore St
Hollis, OK 73550
Phone (580) 688-2800

Organizations & group practices 12

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 4

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1315872000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1761782400000",
    "number": "1831471101",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1200 E PECAN ST",
            "city": "ALTUS",
            "state": "OK",
            "postal_code": "735216141",
            "telephone_number": "580-379-5000",
            "fax_number": "580-379-5509"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "205 S PARK LN",
            "city": "ALTUS",
            "state": "OK",
            "postal_code": "735215755",
            "telephone_number": "580-379-6710",
            "fax_number": "580-379-6714"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STEPHENS",
        "first_name": "MANDA",
        "middle_name": "LEA",
        "name_prefix": "Mrs.",
        "credential": "APRN, CNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-09-13",
        "last_updated": "2025-10-30",
        "certification_date": "2025-10-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "OK",
            "license": "66290",
            "primary": true
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "OK",
            "license": "66290",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200388530A",
            "state": "OK"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "MandaStephens@direct.jcmh.com",
            "affiliation": "N",
            "address_1": "205 S Park Ln",
            "city": "Altus",
            "state": "OK",
            "country_code": "US",
            "postal_code": "735215755",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Altus, OK

Sources for this page

Verify at the official NPI Registry.