Healthcare Provider Details

I. General information

NPI: 1407678006
Provider Name (Legal Business Name): BRANITA DAWN JAYNE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: BRANITA DAWN BRAND

II. Dates (important events)

Enumeration Date: 10/26/2024
Last Update Date: 10/26/2024
Certification Date: 10/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4401 W MEMORIAL RD STE 143
OKLAHOMA CITY OK
73134-1787
US

IV. Provider business mailing address

2660 S LUTHER RD
HARRAH OK
73045-6368
US

V. Phone/Fax

Practice location:
  • Phone: 405-486-8600
  • Fax:
Mailing address:
  • Phone: 405-823-7214
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License NumberRN2382427
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number10025322
License Number StateOR
# 3
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License NumberR0091363
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: