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NPI Code Detail

MEDICARE: JORDAN BROWN

MEDICARE: JORDAN 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
1390200000XStudent in an Organized Health Care Education/Training ProgramOK

General Provider Information

NPI Number : 1083573844
Entity Type Code : Individual
Provider Name (Legal Business Name) : JORDAN BROWN
Provider Business Mailing Address
First Line : 3710 W 110TH PL S
Second Line :
City : JENKS
State : OK
Zip : 74037-1820
Country : US
Telephone Number : 918-557-7369
Fax Number :
Provider Business Practice Location Address
First Line : 1111 W 17TH ST
Second Line :
City : TULSA
State : OK
Zip : 74107-1886
Country : US
Telephone Number : 918-561-8324
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/19/2026
Last Update Date : 01/19/2026

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Directions to “ JORDAN BROWN ” Practice Location

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