Provider Demographics
NPI:1588706295
Name:MERCER, AMANDA JEAN (BS CMCAF)
Entity type:Individual
Prefix:MISS
First Name:AMANDA
Middle Name:JEAN
Last Name:MERCER
Suffix:
Gender:F
Credentials:BS CMCAF
Other - Prefix:MISS
Other - First Name:MANDY
Other - Middle Name:JEAN
Other - Last Name:MERCER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:BS CMCAF
Mailing Address - Street 1:650 S PEORIA
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74120-4429
Mailing Address - Country:US
Mailing Address - Phone:918-587-9471
Mailing Address - Fax:918-560-0137
Practice Address - Street 1:11740 E 21ST ST
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74129-1820
Practice Address - Country:US
Practice Address - Phone:918-437-9495
Practice Address - Fax:918-234-4554
Is Sole Proprietor?:No
Enumeration Date:2007-02-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator