Healthcare Provider Details

I. General information

NPI: 1528048857
Provider Name (Legal Business Name): JON MILES BROWN CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/20/2006
Last Update Date: 02/02/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2220 W IOWA AVE
CHICKASHA OK
73018-2738
US

IV. Provider business mailing address

2220 W IOWA AVE
CHICKASHA OK
73018-2738
US

V. Phone/Fax

Practice location:
  • Phone: 405-224-2300
  • Fax: 405-779-2143
Mailing address:
  • Phone: 405-224-2300
  • Fax: 405-779-2143

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberR0066268
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: