Healthcare Provider Details

I. General information

NPI: 1134943301
Provider Name (Legal Business Name): BROOK NICOLE MCBRAYER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/13/2024
Last Update Date: 12/09/2025
Certification Date: 12/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 E LINCOLN RD
IDABEL OK
74745-7353
US

IV. Provider business mailing address

290 COTTON MOSS RD
VALLIANT OK
74764-5313
US

V. Phone/Fax

Practice location:
  • Phone: 580-286-6639
  • Fax:
Mailing address:
  • Phone: 903-715-0151
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: