Provider Demographics
NPI:1114105640
Name:MCEACHERN, ANDREA ELLEN (DO)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:ELLEN
Last Name:MCEACHERN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1425 N MAIN ST STE 1
Mailing Address - Street 2:
Mailing Address - City:FAIRVIEW
Mailing Address - State:OK
Mailing Address - Zip Code:73737-2703
Mailing Address - Country:US
Mailing Address - Phone:580-227-8647
Mailing Address - Fax:580-603-8602
Practice Address - Street 1:1425 N MAIN ST STE 1
Practice Address - Street 2:
Practice Address - City:FAIRVIEW
Practice Address - State:OK
Practice Address - Zip Code:73737-2703
Practice Address - Country:US
Practice Address - Phone:580-227-8647
Practice Address - Fax:580-603-8602
Is Sole Proprietor?:No
Enumeration Date:2008-02-06
Last Update Date:2022-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4535207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200136010BMedicaid
OK200136010AMedicaid