Healthcare Provider Details

I. General information

NPI: 1861352841
Provider Name (Legal Business Name): JACQUELINE NICOLE BREESE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/13/2025
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3460 E FRANK PHILLIPS BLVD
BARTLESVILLE OK
74006-2406
US

IV. Provider business mailing address

402752 W 2600 RD
BARTLESVILLE OK
74006-0515
US

V. Phone/Fax

Practice location:
  • Phone: 918-332-3600
  • Fax: 918-948-6535
Mailing address:
  • Phone: 918-332-3600
  • Fax: 918-948-6535

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SA2200X
TaxonomyAdult Health Clinical Nurse Specialist
License Number229888
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code163WP2201X
TaxonomyAmbulatory Care Registered Nurse
License NumberR0099385
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: