Healthcare Provider Details

I. General information

NPI: 1740969641
Provider Name (Legal Business Name): ANDREA JAMES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2023
Last Update Date: 01/22/2025
Certification Date: 01/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 1/4 MILE NORTH HIGHWAY 281
ANADARKO OK
73005
US

IV. Provider business mailing address

PO BOX 729
ANADARKO OK
73005-0729
US

V. Phone/Fax

Practice location:
  • Phone: 405-247-8675
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number319189
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number7198
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: