Healthcare Provider Details

I. General information

NPI: 1780592907
Provider Name (Legal Business Name): JANSON BRITT KING
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2026
Last Update Date: 08/29/2026
Certification Date: 08/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 S TUCKER DR
TULSA OK
74104-9700
US

IV. Provider business mailing address

752 STALLARD RD
HOMINY OK
74035-6415
US

V. Phone/Fax

Practice location:
  • Phone: 918-631-2000
  • Fax:
Mailing address:
  • Phone: 918-500-6498
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: