Provider Demographics
NPI:1639838956
Name:KOEHLER, BRENNA R
Entity Type:Individual
Prefix:
First Name:BRENNA
Middle Name:R
Last Name:KOEHLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 E SYCAMORE ST
Mailing Address - Street 2:
Mailing Address - City:HOLLIS
Mailing Address - State:OK
Mailing Address - Zip Code:73550-1436
Mailing Address - Country:US
Mailing Address - Phone:580-318-7379
Mailing Address - Fax:
Practice Address - Street 1:400 E SYCAMORE ST
Practice Address - Street 2:
Practice Address - City:HOLLIS
Practice Address - State:OK
Practice Address - Zip Code:73550-1436
Practice Address - Country:US
Practice Address - Phone:580-688-2800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-14
Last Update Date:2021-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator