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General NPI Number Information
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NPI Number | 1407690118
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Entity Type | Organization
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Legal Business Name | BRAIN THRIVE, PLLC
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Dates
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Enumeration Date | 06/19/2024
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Last Update Date | 08/04/2025
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Provider Practice Location Address
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Address Line | 15805 NE 23RD ST
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City | CHOCTAW
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State | OK
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Zip | 73020-8428
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Country | US
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Telephone | 405-390-0596
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Fax | 888-440-1974
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Provider Business Mailing Address
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Address Line | 15805 NE 23RD ST
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City | CHOCTAW
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State | OK
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Zip | 73020-8428
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Country | US
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Telephone | 405-390-0596
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Fax | 888-440-1974
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Authorized Official
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Title or Position | OWNER/PROVIDER
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Name | TODD J RAMER
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Credential | APRN, CCNS
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Telephone | 405-390-0596
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number |
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License Number State |
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