Healthcare Provider Details

I. General information

NPI: 1225797111
Provider Name (Legal Business Name): BRIANNA D COLE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/08/2021
Last Update Date: 12/08/2021
Certification Date: 12/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

128 N 12TH AVE
DURANT OK
74701-4718
US

IV. Provider business mailing address

PO BOX 1030
ANTLERS OK
74523-1030
US

V. Phone/Fax

Practice location:
  • Phone: 580-745-9276
  • Fax: 580-920-9056
Mailing address:
  • Phone: 580-298-2830
  • Fax: 580-298-6723

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: