MEDICARE: BRANDI A KAMMERER APRN CNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	89215	OK

General Provider Information

NPI Number	:	1558682989
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRANDI A KAMMERER APRN CNP

Provider Business Mailing Address
First Line	:	2716 SW 44TH ST
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73119-3339
Country	:	US
Telephone Number	:	405-778-0700
Fax Number	:	405-778-4484

Provider Business Practice Location Address
First Line	:	2716 SW 44TH ST
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73119-3339
Country	:	US
Telephone Number	:	405-778-0700
Fax Number	:	405-778-4484

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/21/2010
Last Update Date	:	07/02/2015

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