Healthcare Provider Details

I. General information

NPI: 1386086148
Provider Name (Legal Business Name): ANDREA R DAUGHTREY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/22/2013
Last Update Date: 07/22/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

209 S 21 ST
DUNCAN OK
73533
US

IV. Provider business mailing address

209 S 21 STREET
DUNCAN OK
73533
US

V. Phone/Fax

Practice location:
  • Phone: 580-606-3492
  • Fax:
Mailing address:
  • Phone: 580-606-3492
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: