MEDICARE: ANDREA KINKEADE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1184165557
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDREA KINKEADE

Provider Business Mailing Address
First Line	:	521 E FORT WORTH DR
Second Line	:
City	:	BROKEN ARROW
State	:	OK
Zip	:	74012-4314
Country	:	US
Telephone Number	:	918-574-1004
Fax Number	:

Provider Business Practice Location Address
First Line	:	521 E FORT WORTH DR
Second Line	:
City	:	BROKEN ARROW
State	:	OK
Zip	:	74012-4314
Country	:	US
Telephone Number	:	918-574-1004
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/17/2017
Last Update Date	:	03/17/2017

Similar Medicare Providers

1609425008 — MRS. JON ANN ESPONGE APRN, FNP-C
Practice Location Address:

2249 W WASHINGTON ST
BROKEN ARROW, OK
74012-6703

Practice Phone: 918-280-9679
Practice Fax:

1083433569 — AUDREY ROBERTS
Practice Location Address:

4416 W HOUSTON ST
BROKEN ARROW, OK
74012-4645

Practice Phone: 918-288-0027
Practice Fax:

1508073438 — DR. GREGORY D SEGRAVES D.D.S., M.S.
Practice Location Address:

4716 W URBANA ST STE 100
BROKEN ARROW, OK
74012-6162

Practice Phone: 918-449-5800
Practice Fax: 918-455-8958

1730618760 — DR. CHRISTOPHER KEVIN RAY DDS
Practice Location Address:

4716 W URBANA ST STE 100
BROKEN ARROW, OK
74012-6162

Practice Phone: 918-449-5800
Practice Fax: 918-455-8958

1205450319 — KIPLEY POWELL DDS
Practice Location Address:

4716 W URBANA ST STE 100
BROKEN ARROW, OK
74012-6162

Practice Phone: 918-449-5800
Practice Fax: 918-449-5800

1003313594 — DR. CODY HAYES MUMMA DDS
Practice Location Address:

4716 W URBANA ST
BROKEN ARROW, OK
74012-6162

Practice Phone: 918-449-5800
Practice Fax: 918-455-8958

Directions to “ ANDREA KINKEADE ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.