MEDICARE: BYRON KEITH BRANNON

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	101YM0800X	Mental Health Counselor

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1285870626
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BYRON KEITH BRANNON

Provider Business Mailing Address
First Line	:	10613 REITER DR
Second Line	:
City	:	MIDWEST CITY
State	:	OK
Zip	:	73130-6020
Country	:	US
Telephone Number	:	405-455-7278
Fax Number	:

Provider Business Practice Location Address
First Line	:	10613 REITER DR
Second Line	:
City	:	MIDWEST CITY
State	:	OK
Zip	:	73130-6020
Country	:	US
Telephone Number	:	405-455-7278
Fax Number	:

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

Provider Enumeration Date	:	01/06/2009
Last Update Date	:	01/06/2009

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Directions to “ BYRON KEITH BRANNON ” Practice Location

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