Provider Demographics
NPI:1710994850
Name:KRITTENBRINK, ANDREA L (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:ANDREA
Middle Name:L
Last Name:KRITTENBRINK
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MISS
Other - First Name:ANDREA
Other - Middle Name:L
Other - Last Name:MENDELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:1491 HEALTH CENTER PARKWAY
Mailing Address - Street 2:
Mailing Address - City:YUKON
Mailing Address - State:OK
Mailing Address - Zip Code:73099-6767
Mailing Address - Country:US
Mailing Address - Phone:405-806-2200
Mailing Address - Fax:405-806-2207
Practice Address - Street 1:1491 HEALTH CENTER PARKWAY
Practice Address - Street 2:
Practice Address - City:YUKON
Practice Address - State:OK
Practice Address - Zip Code:73099-6767
Practice Address - Country:US
Practice Address - Phone:405-806-2200
Practice Address - Fax:405-806-2207
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2011-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1337363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKP00268190OtherRAILROAD MEDICARE
OK200025260AMedicaid
OK241419503Medicare PIN
OK200025260AMedicaid