Provider Demographics
NPI:1013345305
Name:MEEHAN, BROOKE VISSER (FNP-BC, ACHPN)
Entity Type:Individual
Prefix:MRS
First Name:BROOKE
Middle Name:VISSER
Last Name:MEEHAN
Suffix:
Gender:F
Credentials:FNP-BC, ACHPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2204 E 47TH ST
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74105-4921
Mailing Address - Country:US
Mailing Address - Phone:202-415-2781
Mailing Address - Fax:
Practice Address - Street 1:2204 E 47TH ST
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74105-4921
Practice Address - Country:US
Practice Address - Phone:202-415-2781
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-10-23
Last Update Date:2022-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCRN1007586363L00000X
OKR0082734363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner