Provider Demographics
NPI:1003697517
Name:PATTON, AMANDA JANE
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:JANE
Last Name:PATTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8200 NW 36TH TER
Mailing Address - Street 2:
Mailing Address - City:BETHANY
Mailing Address - State:OK
Mailing Address - Zip Code:73008-3532
Mailing Address - Country:US
Mailing Address - Phone:405-264-3184
Mailing Address - Fax:
Practice Address - Street 1:8200 NW 36TH TER
Practice Address - Street 2:
Practice Address - City:BETHANY
Practice Address - State:OK
Practice Address - Zip Code:73008-3532
Practice Address - Country:US
Practice Address - Phone:405-264-3184
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-10
Last Update Date:2023-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator