Provider Demographics
NPI:1073850822
Name:BEAN, ANDREA ANN (PA-C)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:ANN
Last Name:BEAN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:908 N. ROCKFORD RD
Mailing Address - Street 2:SUITE G
Mailing Address - City:ARDMORE
Mailing Address - State:OK
Mailing Address - Zip Code:73401
Mailing Address - Country:US
Mailing Address - Phone:580-490-9411
Mailing Address - Fax:580-490-9415
Practice Address - Street 1:908 N. ROCKFORD RD
Practice Address - Street 2:SUITE G
Practice Address - City:ARDMORE
Practice Address - State:OK
Practice Address - Zip Code:73401
Practice Address - Country:US
Practice Address - Phone:580-490-9411
Practice Address - Fax:580-490-9415
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-14
Last Update Date:2024-03-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OKAPA2237363AM0700X
OK2237363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical