=====================================================
General NPI Number Information
=====================================================
NPI Number | 1578010716
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | BRANDI GYNN HARDEN APRN-CNP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/06/2016
-----------------------------------------------------
Last Update Date | 01/05/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 36640 HWY 270 & BARKING WATER RD
-----------------------------------------------------
City | WEWOKA
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 74884
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 405-257-6282
-----------------------------------------------------
Fax | 405-257-3344
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4785 COUNTY ROAD 1520
-----------------------------------------------------
City | ADA
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 74820
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 580-421-7281
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 163W00000X
-----------------------------------------------------
Taxonomy Name | Registered Nurse
-----------------------------------------------------
License Number | 91059
-----------------------------------------------------
License Number State | OK
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | 91059
-----------------------------------------------------
License Number State | OK
-----------------------------------------------------