Provider Demographics
NPI:1497322960
Name:BURCH, AMANDA
Entity Type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:
Last Name:BURCH
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:AMANDA
Other - Middle Name:D
Other - Last Name:DENVER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1055 S HOUSTON AVE
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74127-9043
Mailing Address - Country:US
Mailing Address - Phone:918-921-3200
Mailing Address - Fax:
Practice Address - Street 1:1055 S HOUSTON AVE W
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74127-9014
Practice Address - Country:US
Practice Address - Phone:918-921-3200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-04
Last Update Date:2022-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator