Healthcare Provider Details

I. General information

NPI: 1689026353
Provider Name (Legal Business Name): ANDREA LOUISE ROOT MSN, APRN-CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MS. ANDREA LOUISE LEE

II. Dates (important events)

Enumeration Date: 07/06/2016
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 S COUNTRY CLUB RD
EL RENO OK
73036-5427
US

IV. Provider business mailing address

508 W VANDAMENT AVE STE 100
YUKON OK
73099-4665
US

V. Phone/Fax

Practice location:
  • Phone: 405-295-2900
  • Fax:
Mailing address:
  • Phone: 405-350-8100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number106733
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: