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NPI Code Detail

MEDICARE: JESSICA LYNN BRACKETT

MEDICARE: JESSICA LYNN BRACKETT
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
1175T00000XPeer SpecialistOK

General Provider Information

NPI Number : 1558147710
Entity Type Code : Individual
Provider Name (Legal Business Name) : JESSICA LYNN BRACKETT
Provider Business Mailing Address
First Line : 14400 BOGERT PKWY
Second Line :
City : OKLAHOMA CITY
State : OK
Zip : 73134-2652
Country : US
Telephone Number : 405-652-2456
Fax Number :
Provider Business Practice Location Address
First Line : 14400 BOGERT PKWY
Second Line :
City : OKLAHOMA CITY
State : OK
Zip : 73134-2652
Country : US
Telephone Number : 405-652-2456
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/05/2023
Last Update Date : 09/05/2023

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Directions to “ JESSICA LYNN BRACKETT ” Practice Location

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