Healthcare Provider Details

I. General information

NPI: 1588097836
Provider Name (Legal Business Name): TABETHA JAREL BROWN APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2013
Last Update Date: 02/14/2024
Certification Date: 02/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 W ROBERT ST
POTEAU OK
74953-2942
US

IV. Provider business mailing address

210 W ROBERT ST
POTEAU OK
74953-2942
US

V. Phone/Fax

Practice location:
  • Phone: 918-649-0069
  • Fax: 918-649-0067
Mailing address:
  • Phone: 918-649-0069
  • Fax: 918-649-0067

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SF0001X
TaxonomyFamily Health Clinical Nurse Specialist
License Number100665
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: