Healthcare Provider Details

I. General information

NPI: 1720797293
Provider Name (Legal Business Name): ANDREA DOWNING
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/23/2022
Last Update Date: 10/21/2024
Certification Date: 10/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

116 S WILSON ST
VINITA OK
74301-3730
US

IV. Provider business mailing address

2225 N MAIN ST
MIAMI OK
74354-1620
US

V. Phone/Fax

Practice location:
  • Phone: 918-542-4101
  • Fax: 918-256-1430
Mailing address:
  • Phone: 918-542-4101
  • Fax: 918-542-4410

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number0-24-15524
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: