Provider Demographics
NPI:1609672955
Name:REED, AMANDA DAWN (PHD, CHES)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:DAWN
Last Name:REED
Suffix:
Gender:
Credentials:PHD, CHES
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9100 YASSIR BLVD
Mailing Address - Street 2:
Mailing Address - City:YUKON
Mailing Address - State:OK
Mailing Address - Zip Code:73099-3585
Mailing Address - Country:US
Mailing Address - Phone:405-567-5508
Mailing Address - Fax:
Practice Address - Street 1:9100 YASSIR BLVD
Practice Address - Street 2:
Practice Address - City:YUKON
Practice Address - State:OK
Practice Address - Zip Code:73099-3585
Practice Address - Country:US
Practice Address - Phone:405-567-5508
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-19
Last Update Date:2025-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
21332171400000X, 174H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator
No171400000XOther Service ProvidersHealth & Wellness Coach