Provider Demographics
NPI:1629763636
Name:CLEVENGER, ANDREA NICOLE
Entity Type:Individual
Prefix:MS
First Name:ANDREA
Middle Name:NICOLE
Last Name:CLEVENGER
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 1:400 N WALKER AVE
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73102-1886
Mailing Address - Country:US
Mailing Address - Phone:405-252-0218
Mailing Address - Fax:
Practice Address - Street 1:400 N WALKER AVE
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73102-1886
Practice Address - Country:US
Practice Address - Phone:405-252-0218
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-06
Last Update Date:2023-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist
No251S00000XAgenciesCommunity/Behavioral Health