Healthcare Provider Details

I. General information

NPI: 1467365239
Provider Name (Legal Business Name): BREANNA AEILEEN HOOVER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2026
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11612 SW 10TH ST
YUKON OK
73099-7054
US

IV. Provider business mailing address

11612 SW 10TH ST
YUKON OK
73099-7054
US

V. Phone/Fax

Practice location:
  • Phone: 405-550-5040
  • Fax:
Mailing address:
  • Phone: 405-550-5040
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: