Healthcare Provider Details

I. General information

NPI: 1205695137
Provider Name (Legal Business Name): AMBER HUNNICUTT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/14/2024
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

314 S BROADWAY AVE STE 106
ADA OK
74820-5818
US

IV. Provider business mailing address

1300 HOPPE BLVD STE 3
ADA OK
74820-2319
US

V. Phone/Fax

Practice location:
  • Phone: 580-235-0210
  • Fax: 580-235-0211
Mailing address:
  • Phone: 405-857-8280
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: