Healthcare Provider Details

I. General information

NPI: 1477478303
Provider Name (Legal Business Name): AMBER RENEE KING
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/11/2026
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2548 E KENOSHA ST
BROKEN ARROW OK
74014-6712
US

IV. Provider business mailing address

2548 E KENOSHA ST
BROKEN ARROW OK
74014-6712
US

V. Phone/Fax

Practice location:
  • Phone: 918-382-8961
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number21250
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: