Healthcare Provider Details

I. General information

NPI: 1518598564
Provider Name (Legal Business Name): ANDREA ALLEN APRN, CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/29/2020
Last Update Date: 09/10/2025
Certification Date: 09/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8430 N 123RD EAST AVE
OWASSO OK
74055-2130
US

IV. Provider business mailing address

8430 N 123RD EAST AVE
OWASSO OK
74055-2130
US

V. Phone/Fax

Practice location:
  • Phone: 918-401-4770
  • Fax: 918-401-4779
Mailing address:
  • Phone: 918-401-4770
  • Fax: 918-401-4779

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number107874
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: