Healthcare Provider Details

I. General information

NPI: 1598634875
Provider Name (Legal Business Name): JENNY BRUNO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/04/2025
Last Update Date: 11/04/2025
Certification Date: 11/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5310 E 31ST ST
TULSA OK
74135-5012
US

IV. Provider business mailing address

14544 E 460 RD
CLAREMORE OK
74017-2766
US

V. Phone/Fax

Practice location:
  • Phone: 918-744-4800
  • Fax:
Mailing address:
  • Phone: 806-283-1573
  • Fax: 417-773-9032

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: