Healthcare Provider Details

I. General information

NPI: 1275477655
Provider Name (Legal Business Name): JODY BRAYTON HALLMAN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/16/2026
Last Update Date: 04/16/2026
Certification Date: 04/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 N HIGH ST
ANTLERS OK
74523-2238
US

IV. Provider business mailing address

301 N HIGH ST
ANTLERS OK
74523-2238
US

V. Phone/Fax

Practice location:
  • Phone: 580-271-7055
  • Fax: 580-271-7056
Mailing address:
  • Phone: 580-271-7055
  • Fax: 580-271-7056

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: