Healthcare Provider Details

I. General information

NPI: 1194165258
Provider Name (Legal Business Name): AMANDA RENE REED D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMANDA RENE PROPST DO

II. Dates (important events)

Enumeration Date: 07/03/2013
Last Update Date: 05/05/2023
Certification Date: 05/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10109 E 79TH ST
TULSA OK
74133-4564
US

IV. Provider business mailing address

10109 E 79TH ST
TULSA OK
74133-4564
US

V. Phone/Fax

Practice location:
  • Phone: 918-233-9550
  • Fax:
Mailing address:
  • Phone: 918-233-9550
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number5471
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number5471
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: