Healthcare Provider Details

I. General information

NPI: 1225922156
Provider Name (Legal Business Name): AMANDA CUPP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2025
Last Update Date: 06/05/2025
Certification Date: 06/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1222 10TH ST
WOODWARD OK
73801-3156
US

IV. Provider business mailing address

1222 10TH ST
WOODWARD OK
73801-3156
US

V. Phone/Fax

Practice location:
  • Phone: 580-256-8615
  • Fax: 580-256-8643
Mailing address:
  • Phone: 580-256-8615
  • Fax: 580-256-8643

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: