Healthcare Provider Details

I. General information

NPI: 1669059374
Provider Name (Legal Business Name): DR. AMANDA KAY SCHOVANEC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2021
Last Update Date: 03/27/2021
Certification Date: 03/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

717 S HOUSTON AVE STE 200
TULSA OK
74127-9005
US

IV. Provider business mailing address

20692 E 45TH ST S
BROKEN ARROW OK
74014-8743
US

V. Phone/Fax

Practice location:
  • Phone: 918-586-4500
  • Fax:
Mailing address:
  • Phone: 405-699-2098
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: