Individual
ANDREA CAMPBELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2617 GENERAL PERSHING BLVD, OKLAHOMA CITY, OK 73107-6437
(405) 858-2700
Mailing address
4510 N ASBURY AVE, BETHANY, OK 73008-2617
(405) 764-5211
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
D082252630
DRIVER LICENSE
OK
Enumeration date
10/28/2021
Last updated
10/28/2021
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