Healthcare Provider Details

I. General information

NPI: 1194165258
Provider Name (Legal Business Name): AMANDA RENE BOVINE D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMANDA RENE REED DO

II. Dates (important events)

Enumeration Date: 07/03/2013
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2900 N MAIN ST
MUSKOGEE OK
74401-4078
US

IV. Provider business mailing address

2900 N MAIN ST
MUSKOGEE OK
74401-4078
US

V. Phone/Fax

Practice location:
  • Phone: 918-300-1320
  • Fax: 918-300-1540
Mailing address:
  • Phone: 918-300-1320
  • Fax: 918-300-1540

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number5471
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number5471
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: