Healthcare Provider Details

I. General information

NPI: 1255058392
Provider Name (Legal Business Name): AMBER N EVANS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/19/2022
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4900 SW 121ST PL
OKLAHOMA CITY OK
73173-8863
US

IV. Provider business mailing address

4900 SW 121ST PL
OKLAHOMA CITY OK
73173-8863
US

V. Phone/Fax

Practice location:
  • Phone: 405-623-7177
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number12487
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: