Provider Demographics
NPI:1518491414
Name:PARKER, ANDRAQ
Entity Type:Individual
Prefix:
First Name:ANDRAQ
Middle Name:
Last Name:PARKER
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 1:7705 WEST PARKWAY BLVD 104
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74106
Mailing Address - Country:US
Mailing Address - Phone:918-904-9564
Mailing Address - Fax:
Practice Address - Street 1:7705 W PARKWAY BLVD APT 104
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74127-5536
Practice Address - Country:US
Practice Address - Phone:918-904-9564
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-18
Last Update Date:2017-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator