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MISS BRENDA DARLENE JETTON
>> Specialist >> Other Service ProvidersRegistrant NPI Number: 1144435405
Individual Registrant:MISS BRENDA DARLENE JETTON
Gender: F
Not Sole Proprietor
Gender: F
Not Sole Proprietor
Location and contact information for practice:
18414 S HWY 75 MOUNDS, OK 74047-7411 US
Tel: 918-827-4022 Fax: --
Tel: 918-827-4022 Fax: --
Contact information for business:
18414 S HWY 75 MOUNDS, OK 74047-7411 US
Tel: 918-827-4022 Fax: --
Tel: 918-827-4022 Fax: --
Registration Information:
NPI: 1144435405
Entity Type: Individual
Entity Type: Individual
Specialty information:
| Primary | Code | Category/Description | State | License Number |
|---|---|---|---|---|
| N | 174400000X | Other Service Providers Specialist | OK | 200063440A |
| N | 174400000X | Other Service Providers Specialist | OK | 20063440B |
| Y | 174400000X | Other Service Providers Specialist | OK | 20063440C |
Legacy codes, insurance codes and state license numbers:
| Issuer | Number | State | Type |
|---|---|---|---|
