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NPI Code Detail

MEDICARE: AMANDA RENE BOVINE D.O.

MEDICARE: AMANDA RENE BOVINE D.O.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207QA0401XAddiction Medicine (Family Medicine) Physician5471OK
2207Q00000XFamily Medicine Physician5471OK

General Provider Information

NPI Number : 1194165258
Entity Type Code : Individual
Provider Name (Legal Business Name) : AMANDA RENE BOVINE D.O.
Provider Business Mailing Address
First Line : 2900 N MAIN ST
Second Line :
City : MUSKOGEE
State : OK
Zip : 74401-4078
Country : US
Telephone Number : 918-300-1320
Fax Number : 918-300-1540
Provider Business Practice Location Address
First Line : 2900 N MAIN ST
Second Line :
City : MUSKOGEE
State : OK
Zip : 74401-4078
Country : US
Telephone Number : 918-300-1320
Fax Number : 918-300-1540
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/03/2013
Last Update Date : 06/22/2026

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Directions to “ AMANDA RENE BOVINE D.O.” Practice Location

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