MEDICARE: MS. SKY-NATIA ELECTRAUNIQUE BROWN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst		OK

General Provider Information

NPI Number	:	1023359791
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SKY-NATIA ELECTRAUNIQUE BROWN

Provider Business Mailing Address
First Line	:	1435 NE 26TH ST
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73111-3064
Country	:	US
Telephone Number	:	405-468-4977
Fax Number	:

Provider Business Practice Location Address
First Line	:	7901 NE 10TH ST
Second Line	:	B.106
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73110-3600
Country	:	US
Telephone Number	:	405-736-0056
Fax Number	:	405-736-0057

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/06/2013
Last Update Date	:	03/06/2013

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