Healthcare Provider Details

I. General information

NPI: 1306233176
Provider Name (Legal Business Name): AMANDA SPENCER APRN. CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMANDA ANDERSON

II. Dates (important events)

Enumeration Date: 04/20/2015
Last Update Date: 02/24/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4050 W MEMORIAL RD
OKLAHOMA CITY OK
73120-8382
US

IV. Provider business mailing address

4050 W MEMORIAL RD
OKLAHOMA CITY OK
73120-8382
US

V. Phone/Fax

Practice location:
  • Phone: 405-608-3800
  • Fax: 405-680-3838
Mailing address:
  • Phone: 405-608-3800
  • Fax: 405-680-3838

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number96251
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: