Healthcare Provider Details

I. General information

NPI: 1659869881
Provider Name (Legal Business Name): BRENT BYERS APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/24/2018
Last Update Date: 02/07/2024
Certification Date: 02/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3040 NW 179TH CT
EDMOND OK
73012
US

IV. Provider business mailing address

7017 SW 90TH ST
OKLAHOMA CITY OK
73169-3739
US

V. Phone/Fax

Practice location:
  • Phone: 405-315-8440
  • Fax:
Mailing address:
  • Phone: 405-315-8440
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR0069144
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number69144
License Number StateOK
# 3
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberR0069144
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: