Healthcare Provider Details

I. General information

NPI: 1033764329
Provider Name (Legal Business Name): AMANDA MARIE HIBBS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2019
Last Update Date: 12/01/2025
Certification Date: 12/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

922 W 14TH ST
SULPHUR OK
73086-4446
US

IV. Provider business mailing address

922 W 14TH ST
SULPHUR OK
73086-4446
US

V. Phone/Fax

Practice location:
  • Phone: 580-618-5692
  • Fax:
Mailing address:
  • Phone: 580-618-5692
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number21560
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: