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MISS BRENDA DARLENE JETTON

>> Specialist >> Other Service Providers

Registrant NPI Number: 1144435405

Individual Registrant:
MISS BRENDA DARLENE JETTON 
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: --

Contact information for business:
18414 S HWY 75  MOUNDS, OK 74047-7411 US
Tel: 918-827-4022  Fax: --

Registration Information:
NPI: 1144435405
Entity Type: Individual

Specialty information:

PrimaryCodeCategory/DescriptionStateLicense Number
N174400000XOther Service Providers
Specialist
OK200063440A
N174400000XOther Service Providers
Specialist
OK20063440B
Y174400000XOther Service Providers
Specialist
OK20063440C

Legacy codes, insurance codes and state license numbers:

IssuerNumberStateType




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