Provider Demographics
NPI:1740527225
Name:JEFFERSON, BRANDI CAROL
Entity type:Individual
Prefix:MRS
First Name:BRANDI
Middle Name:CAROL
Last Name:JEFFERSON
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 1:55 15TH AVE NW
Mailing Address - Street 2:
Mailing Address - City:ARDMORE
Mailing Address - State:OK
Mailing Address - Zip Code:73401-2047
Mailing Address - Country:US
Mailing Address - Phone:580-277-0890
Mailing Address - Fax:
Practice Address - Street 1:55 15TH AVE NW
Practice Address - Street 2:
Practice Address - City:ARDMORE
Practice Address - State:OK
Practice Address - Zip Code:73401-2047
Practice Address - Country:US
Practice Address - Phone:580-277-0890
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-03
Last Update Date:2013-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist