Healthcare Provider Details

I. General information

NPI: 1639927171
Provider Name (Legal Business Name): BRANDY NICOLE SEWARD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/09/2024
Last Update Date: 05/09/2024
Certification Date: 05/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2701 W I 44 SERVICE RD
OKLAHOMA CITY OK
73112-3775
US

IV. Provider business mailing address

7635 E PRAIRIE GROVE RD
GUTHRIE OK
73044-6850
US

V. Phone/Fax

Practice location:
  • Phone: 866-848-7555
  • Fax:
Mailing address:
  • Phone: 580-485-7825
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: