Provider Demographics
NPI:1396412227
Name:RUPE, AMANDA N
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:N
Last Name:RUPE
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 1:1772 N 4364
Mailing Address - Street 2:
Mailing Address - City:PRYOR
Mailing Address - State:OK
Mailing Address - Zip Code:74361-2793
Mailing Address - Country:US
Mailing Address - Phone:918-803-3140
Mailing Address - Fax:
Practice Address - Street 1:19320 E ADMIRAL PL STE B
Practice Address - Street 2:
Practice Address - City:CATOOSA
Practice Address - State:OK
Practice Address - Zip Code:74015-3240
Practice Address - Country:US
Practice Address - Phone:918-340-5503
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-27
Last Update Date:2024-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175T00000XOther Service ProvidersPeer SpecialistGroup - Single Specialty
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst