Provider Demographics
NPI:1871132894
Name:OAKES, ANDREA T (PMHNP-BC)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:T
Last Name:OAKES
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1362 LOBO TRL
Mailing Address - Street 2:
Mailing Address - City:SNOWFLAKE
Mailing Address - State:AZ
Mailing Address - Zip Code:85937-5463
Mailing Address - Country:US
Mailing Address - Phone:928-651-2909
Mailing Address - Fax:
Practice Address - Street 1:2500 E SHOW LOW LAKE RD
Practice Address - Street 2:
Practice Address - City:SHOW LOW
Practice Address - State:AZ
Practice Address - Zip Code:85901-7994
Practice Address - Country:US
Practice Address - Phone:928-537-2951
Practice Address - Fax:928-537-4841
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-23
Last Update Date:2019-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ235857363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health