Individual
ANDREA DAVIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
120 E BROADWAY ST, BOX 236, WETUMKA, OK 74883-4505
(405) 452-3151
Mailing address
6839 S CANTON AVE, TULSA, OK 74136-3402
(918) 494-0612
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
2399
OK
Other
Enumeration date
07/27/2014
Last updated
06/18/2025
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