Andra Lane Wingo, B.S.

Key facts

NPI

1306271663

Entity type

Individual (NPI type 1)

Primary specialty

Mental Health Counselor 101YM0800X

Practice address

413 N Bugg St
Bokchito, OK 74726-1211

Phone

(580) 380-7999

Fax

(580) 564-7309

NPI assigned

Sep 5, 2013

Sex

Female

Sole proprietor

Yes

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Community Pathways Unlimited Inc Clinical Psychologist · Oklahoma City, OK · NPI 1659328284
  Medicare reassignment NPD OK

Medicare participation

Medicare fee-for-service enrollment

Enrolled in OK

Eligible to order & refer

Part B services: Yes · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No

Medicare enrollment records

National Provider Directory

Medicare enrollment (NPD)

Yes

Credentials

Bachelor of Science

Practice roles

Locations

Specialties & licenses

Addresses

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Sep 5, 2013.

{
    "created_epoch": "1378339200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1378339200000",
    "number": "1306271663",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "413 N BUGG ST",
            "city": "BOKCHITO",
            "state": "OK",
            "postal_code": "747261211",
            "telephone_number": "580-380-7999",
            "fax_number": "580-564-7309"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "413 N BUGG ST",
            "city": "BOKCHITO",
            "state": "OK",
            "postal_code": "747261211",
            "telephone_number": "580-380-7999",
            "fax_number": "580-564-7309"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WINGO",
        "first_name": "ANDRA",
        "middle_name": "LANE",
        "credential": "B.S.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2013-09-05",
        "last_updated": "2013-09-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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All providers in Bokchito, OK · Mental Health Counselor in Oklahoma