Healthcare Provider Details

I. General information

NPI: 1013419449
Provider Name (Legal Business Name): AMIKO FALLON ASAMEN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/01/2018
Last Update Date: 12/19/2025
Certification Date: 12/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4515 E 91ST ST STE 201
TULSA OK
74137-2862
US

IV. Provider business mailing address

RR 1 BOX 144 444379 E 956 ROAD
GORE OK
74435-9507
US

V. Phone/Fax

Practice location:
  • Phone: 918-730-9123
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-25-86129
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: