Provider Demographics
NPI:1518852177
Name:RAPER, BRIAN L
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:L
Last Name:RAPER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19005 HILL VALLEY WAY
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73012-0002
Mailing Address - Country:US
Mailing Address - Phone:405-408-6289
Mailing Address - Fax:
Practice Address - Street 1:19005 HILL VALLEY WAY
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73012-0002
Practice Address - Country:US
Practice Address - Phone:405-408-6289
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-12
Last Update Date:2025-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK193388251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)