Healthcare Provider Details

I. General information

NPI: 1376484162
Provider Name (Legal Business Name): JASON BROWN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/03/2026
Last Update Date: 04/03/2026
Certification Date: 04/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3000 UNITED FOUNDERS BLVD STE 124
OKLAHOMA CITY OK
73112-4292
US

IV. Provider business mailing address

317 WILDEWOOD TER
OKLAHOMA CITY OK
73105-1441
US

V. Phone/Fax

Practice location:
  • Phone: 405-646-0455
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: