Healthcare Provider Details

I. General information

NPI: 1174202485
Provider Name (Legal Business Name): AMANDA GAIL HENRY APRN-CNS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2023
Last Update Date: 07/13/2023
Certification Date: 07/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 N PORTER AVE
NORMAN OK
73071-6404
US

IV. Provider business mailing address

5005 RYAN DR
OKLAHOMA CITY OK
73135-4203
US

V. Phone/Fax

Practice location:
  • Phone: 405-307-3863
  • Fax: 405-307-3841
Mailing address:
  • Phone: 405-290-8652
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SA2200X
TaxonomyAdult Health Clinical Nurse Specialist
License Number214262
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: