Healthcare Provider Details

I. General information

NPI: 1306301353
Provider Name (Legal Business Name): JACQUELINE ELANE BRISCOE RRT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/04/2019
Last Update Date: 02/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6032 E 145TH ST S
BIXBY OK
74008-4092
US

IV. Provider business mailing address

6032 E 145TH ST S
BIXBY OK
74008-4092
US

V. Phone/Fax

Practice location:
  • Phone: 786-290-9828
  • Fax:
Mailing address:
  • Phone: 786-290-9828
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code227900000X
TaxonomyRegistered Respiratory Therapist
License NumberRRT4409
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: