MEDICARE: BETHANY DIANNA BROWN CNP

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	363LF0000X	Family Nurse Practitioner	89019	OK

General Provider Information

NPI Number	:	1366848798
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BETHANY DIANNA BROWN CNP

Provider Business Mailing Address
First Line	:	4345 W MEMORIAL RD
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73134-1702
Country	:	US
Telephone Number	:	405-494-3370
Fax Number	:

Provider Business Practice Location Address
First Line	:	836 GARTH BROOKS BLVD STE 215
Second Line	:
City	:	YUKON
State	:	OK
Zip	:	73099-3890
Country	:	US
Telephone Number	:	405-494-3370
Fax Number	:	405-494-3371

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

Provider Enumeration Date	:	11/12/2014
Last Update Date	:	06/17/2025

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