Healthcare Provider Details

I. General information

NPI: 1609342468
Provider Name (Legal Business Name): AMANDA LOUISE WHORTON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/19/2018
Last Update Date: 03/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12451 E 100TH ST N
OWASSO OK
74055-4600
US

IV. Provider business mailing address

6600 S YALE AVE STE 1200
TULSA OK
74136-3361
US

V. Phone/Fax

Practice location:
  • Phone: 918-274-5000
  • Fax:
Mailing address:
  • Phone: 918-488-6687
  • Fax: 918-488-6098

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LN0000X
TaxonomyNeonatal Nurse Practitioner
License Number113613
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: