Provider Demographics
NPI:1609143163
Name:SKELLEY, BRENN NICOLE (BSW)
Entity Type:Individual
Prefix:MRS
First Name:BRENN
Middle Name:NICOLE
Last Name:SKELLEY
Suffix:
Gender:F
Credentials:BSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 S BROADWAY
Mailing Address - Street 2:
Mailing Address - City:HOBART
Mailing Address - State:OK
Mailing Address - Zip Code:73651-1834
Mailing Address - Country:US
Mailing Address - Phone:580-726-3383
Mailing Address - Fax:580-726-3384
Practice Address - Street 1:901 S BROADWAY
Practice Address - Street 2:
Practice Address - City:HOBART
Practice Address - State:OK
Practice Address - Zip Code:73651-1834
Practice Address - Country:US
Practice Address - Phone:580-726-3383
Practice Address - Fax:580-726-3384
Is Sole Proprietor?:No
Enumeration Date:2011-11-28
Last Update Date:2011-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100707910BMedicaid