Healthcare Provider Details

I. General information

NPI: 1407690118
Provider Name (Legal Business Name): BRAIN THRIVE, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/19/2024
Last Update Date: 08/04/2025
Certification Date: 08/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15805 NE 23RD ST
CHOCTAW OK
73020-8428
US

IV. Provider business mailing address

15805 NE 23RD ST
CHOCTAW OK
73020-8428
US

V. Phone/Fax

Practice location:
  • Phone: 405-390-0596
  • Fax: 888-440-1974
Mailing address:
  • Phone: 405-390-0596
  • Fax: 888-440-1974

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: TODD J RAMER
Title or Position: OWNER/PROVIDER
Credential: APRN, CCNS
Phone: 405-390-0596