Healthcare Provider Details

I. General information

NPI: 1669891768
Provider Name (Legal Business Name): JENNIFER BRANSCUM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/16/2014
Last Update Date: 05/08/2026
Certification Date: 05/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22681 VALLEY VIEW RD
POTEAU OK
74953
US

IV. Provider business mailing address

22681 VALLEY VIEW RD
POTEAU OK
74953-9120
US

V. Phone/Fax

Practice location:
  • Phone: 918-658-8358
  • Fax:
Mailing address:
  • Phone: 918-658-8358
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number12262
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: