Provider Demographics
NPI:1194989483
Name:WOODY, AMANDA YVETTE (CST)
Entity type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:YVETTE
Last Name:WOODY
Suffix:
Gender:F
Credentials:CST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3834 S 121ST EAST AVE
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74146-3313
Mailing Address - Country:US
Mailing Address - Phone:918-850-9884
Mailing Address - Fax:
Practice Address - Street 1:3834 S 121ST EAST AVE
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74146-3313
Practice Address - Country:US
Practice Address - Phone:918-850-9884
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-15
Last Update Date:2008-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZS0410XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Technologist