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General NPI Number Information
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NPI Number | 1225868730
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Entity Type | Individual
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Provider Name | AMANDA JEAN MOHR PA-C
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Gender | Female
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Dates
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Enumeration Date | 08/07/2024
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Last Update Date | 09/26/2024
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Provider Practice Location Address
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Address Line | 1200 CHILDRENS AVE STE 10A
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City | OKLAHOMA CITY
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State | OK
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Zip | 73104-4637
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Country | US
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Telephone | 405-271-4412
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Fax |
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Provider Business Mailing Address
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Address Line | 101 NE 53RD ST APT 2406
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City | OKLAHOMA CITY
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State | OK
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Zip | 73105-1874
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Country | US
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Telephone | 701-426-5200
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 5355
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License Number State | OK
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