Provider Demographics
NPI:1689026353
Name:ROOT, ANDREA LOUISE (MSN, APRN-CNP)
Entity Type:Individual
Prefix:MRS
First Name:ANDREA
Middle Name:LOUISE
Last Name:ROOT
Suffix:
Gender:F
Credentials:MSN, APRN-CNP
Other - Prefix:MS
Other - First Name:ANDREA
Other - Middle Name:LOUISE
Other - Last Name:LEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:508 W VANDAMENT AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:YUKON
Mailing Address - State:OK
Mailing Address - Zip Code:73099-4665
Mailing Address - Country:US
Mailing Address - Phone:405-350-8100
Mailing Address - Fax:
Practice Address - Street 1:315 W KANSAS
Practice Address - Street 2:
Practice Address - City:OKARCHE
Practice Address - State:OK
Practice Address - Zip Code:73762-9227
Practice Address - Country:US
Practice Address - Phone:405-263-7557
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-06
Last Update Date:2023-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK106733363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily