Provider Demographics
NPI:1598415747
Name:SHUTT, AMANDA R
Entity Type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:R
Last Name:SHUTT
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:AMANDA
Other - Middle Name:R
Other - Last Name:HAWKINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2217 E 59TH ST APT 717
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74105-7061
Mailing Address - Country:US
Mailing Address - Phone:918-840-8987
Mailing Address - Fax:
Practice Address - Street 1:5310 E 31ST ST
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74135-5018
Practice Address - Country:US
Practice Address - Phone:918-587-9471
Practice Address - Fax:918-560-1399
Is Sole Proprietor?:No
Enumeration Date:2022-03-28
Last Update Date:2022-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator