Healthcare Provider Details

I. General information

NPI: 1689416281
Provider Name (Legal Business Name): BRAXTON CHASE BRATCHER DNP, APRN-CNP, FNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2024
Last Update Date: 07/04/2026
Certification Date: 07/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

503 NE 12TH ST
MOORE OK
73160-5807
US

IV. Provider business mailing address

503 NE 12TH ST
MOORE OK
73160-5807
US

V. Phone/Fax

Practice location:
  • Phone: 405-237-9955
  • Fax:
Mailing address:
  • Phone: 405-237-9955
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number214353
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: