Individual
ANDREA KINKEADE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
521 E FORT WORTH DR, BROKEN ARROW, OK 74012-4314
(918) 574-1004
Mailing address
521 E FORT WORTH DR, BROKEN ARROW, OK 74012-4314
(918) 574-1004
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
03/17/2017
Last updated
03/17/2017
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