MEDICARE: BRANDI JO RICKETTS

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	101Y00000X	Counselor

General Provider Information

NPI Number	:	1760706030
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRANDI JO RICKETTS

Provider Business Mailing Address
First Line	:	11417 MARBELLA DR
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73173-8155
Country	:	US
Telephone Number	:	405-202-3158
Fax Number	:	405-261-2300

Provider Business Practice Location Address
First Line	:	11417 MARBELLA DR
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73173-8155
Country	:	US
Telephone Number	:	405-202-3158
Fax Number	:	405-261-2300

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

Provider Enumeration Date	:	03/16/2010
Last Update Date	:	02/19/2016

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Directions to “ BRANDI JO RICKETTS ” Practice Location

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