Provider Demographics
NPI:1184232753
Name:REYES, BRIANNA NICOLE (APRN-FNP)
Entity type:Individual
Prefix:
First Name:BRIANNA
Middle Name:NICOLE
Last Name:REYES
Suffix:
Gender:F
Credentials:APRN-FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2868 W 111TH PL S
Mailing Address - Street 2:
Mailing Address - City:JENKS
Mailing Address - State:OK
Mailing Address - Zip Code:74037-2426
Mailing Address - Country:US
Mailing Address - Phone:918-409-7780
Mailing Address - Fax:
Practice Address - Street 1:1111 S SAINT LOUIS AVE
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74120-5440
Practice Address - Country:US
Practice Address - Phone:918-619-4400
Practice Address - Fax:918-619-4696
Is Sole Proprietor?:No
Enumeration Date:2020-07-20
Last Update Date:2021-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK126934363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200941840AMedicaid