Provider Demographics
NPI:1508168964
Name:BRUMLEY, BREANNA J (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:BREANNA
Middle Name:J
Last Name:BRUMLEY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:BREANNA
Other - Middle Name:J
Other - Last Name:WALKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9709 E 79TH ST
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74133-4566
Mailing Address - Country:US
Mailing Address - Phone:918-994-4000
Mailing Address - Fax:918-994-4090
Practice Address - Street 1:9709 E 79TH ST
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74133-4566
Practice Address - Country:US
Practice Address - Phone:918-994-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-11-17
Last Update Date:2022-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPT2020-062363AM0700X, 363AM0700X
OK1999363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical