Provider Demographics
NPI:1356948301
Name:SKOUSEN, ANDREW RYAN (DNP)
Entity type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:RYAN
Last Name:SKOUSEN
Suffix:
Gender:M
Credentials:DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11001 E 13TH ST
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74128-4221
Mailing Address - Country:US
Mailing Address - Phone:405-762-2563
Mailing Address - Fax:
Practice Address - Street 1:550 W 125TH PL S STE 200
Practice Address - Street 2:
Practice Address - City:GLENPOOL
Practice Address - State:OK
Practice Address - Zip Code:74033-5026
Practice Address - Country:US
Practice Address - Phone:918-224-7305
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-02
Last Update Date:2020-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKR0116201363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily