Healthcare Provider Details

I. General information

NPI: 1013433077
Provider Name (Legal Business Name): CAITLYN RAYANN BRANNON RN, MSN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2017
Last Update Date: 08/21/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1717B S UTICA AVE STE 205
TULSA OK
74104-5332
US

IV. Provider business mailing address

1717B S UTICA AVE STE 205
TULSA OK
74104-5332
US

V. Phone/Fax

Practice location:
  • Phone: 918-744-2444
  • Fax:
Mailing address:
  • Phone: 918-744-2444
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WD0400X
TaxonomyDiabetes Educator Registered Nurse
License Number109991
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: