Provider Demographics
NPI:1467753004
Name:RECKER, AMANDA REN'EE (FNP-BC, APRN-CNP)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:REN'EE
Last Name:RECKER
Suffix:
Gender:F
Credentials:FNP-BC, APRN-CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 26
Mailing Address - Street 2:1 MEDICAL PLAZA
Mailing Address - City:RATLIFF CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73481-0026
Mailing Address - Country:US
Mailing Address - Phone:580-856-2102
Mailing Address - Fax:580-856-3607
Practice Address - Street 1:1 MEDICAL PLAZA
Practice Address - Street 2:BOX 26
Practice Address - City:RATLIFF CITY
Practice Address - State:OK
Practice Address - Zip Code:73481-0026
Practice Address - Country:US
Practice Address - Phone:580-856-2102
Practice Address - Fax:580-856-3607
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-13
Last Update Date:2024-04-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OK85617363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200314580AMedicaid