Healthcare Provider Details

I. General information

NPI: 1437572070
Provider Name (Legal Business Name): BRANDON KIRK HATTON CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/03/2014
Last Update Date: 02/03/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1923 S UTICA AVE
TULSA OK
74104-6520
US

IV. Provider business mailing address

PO BOX 21228 DEPT. 151
TULSA OK
74121-1228
US

V. Phone/Fax

Practice location:
  • Phone: 918-798-4759
  • Fax:
Mailing address:
  • Phone: 706-650-0705
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number90106
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: