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NPI Code Detail

MEDICARE: AMANDA WHITE

MEDICARE: AMANDA WHITE
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
1103K00000XBehavior Analyst
2175T00000XPeer Specialist

General Provider Information

NPI Number : 1215350228
Entity Type Code : Individual
Provider Name (Legal Business Name) : AMANDA WHITE
Provider Business Mailing Address
First Line : 11909 BARRYWOOD DR
Second Line :
City : OKLAHOMA CITY
State : OK
Zip : 73120-8006
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 14400 BOGERT PKWY
Second Line :
City : OKLAHOMA CITY
State : OK
Zip : 73134-2652
Country : US
Telephone Number : 844-346-7366
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/27/2014
Last Update Date : 10/13/2022

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Directions to “ AMANDA WHITE ” Practice Location

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