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General NPI Number Information
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NPI Number | 1073469615
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Entity Type | Individual
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Provider Name | AMANDA KAY WILLS
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Gender | Female
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Dates
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Enumeration Date | 03/06/2026
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Last Update Date | 03/06/2026
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Provider Practice Location Address
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Address Line | 1629 S MAIN ST
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City | GROVE
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State | OK
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Zip | 74344-5368
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Country | US
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Telephone | 918-557-4496
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Fax |
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Provider Business Mailing Address
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Address Line | 1316 S WILDER TRL
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City | REPUBLIC
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State | MO
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Zip | 65738-2783
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Country | US
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Telephone | 417-920-6969
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 1-26-87571
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License Number State | OK
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