Provider Demographics
NPI:1942882584
Name:FIPPS, AMANDA RENEA
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:RENEA
Last Name:FIPPS
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 1:930 WALL ST
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73069-6319
Mailing Address - Country:US
Mailing Address - Phone:405-384-8588
Mailing Address - Fax:
Practice Address - Street 1:146 SW 134TH ST
Practice Address - Street 2:
Practice Address - City:MOORE
Practice Address - State:OK
Practice Address - Zip Code:73170-1488
Practice Address - Country:US
Practice Address - Phone:405-265-9324
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-23
Last Update Date:2024-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician