Healthcare Provider Details

I. General information

NPI: 1891353967
Provider Name (Legal Business Name): ANITA BRYANT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/03/2019
Last Update Date: 06/08/2022
Certification Date: 06/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

806 CAMPBELL AVE STE A
WARNER OK
74469-5008
US

IV. Provider business mailing address

PO BOX 179
STIGLER OK
74462-0179
US

V. Phone/Fax

Practice location:
  • Phone: 918-463-2837
  • Fax: 918-463-2889
Mailing address:
  • Phone: 918-967-3368
  • Fax: 918-967-3351

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number83161
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: