Healthcare Provider Details

I. General information

NPI: 1093635708
Provider Name (Legal Business Name): DANIEL BRENT ROLLINS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2026
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

805 E ROBINSON ST
NORMAN OK
73071-6610
US

IV. Provider business mailing address

912 BRANCHWOOD DR
NORMAN OK
73072-4182
US

V. Phone/Fax

Practice location:
  • Phone: 405-310-3039
  • Fax:
Mailing address:
  • Phone: 913-850-2375
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License NumberT775879745
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: