Provider Demographics
NPI:1841523594
Name:HAMM, BRANDI SHANTIL (NP)
Entity type:Individual
Prefix:MS
First Name:BRANDI
Middle Name:SHANTIL
Last Name:HAMM
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MS
Other - First Name:BRANDI
Other - Middle Name:SHANTIL
Other - Last Name:WALL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:9276 S 259TH EAST AVE
Mailing Address - Street 2:
Mailing Address - City:BROKEN ARROW
Mailing Address - State:OK
Mailing Address - Zip Code:74014-7828
Mailing Address - Country:US
Mailing Address - Phone:918-812-0562
Mailing Address - Fax:
Practice Address - Street 1:6161 S YALE AVE
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74136-1902
Practice Address - Country:US
Practice Address - Phone:918-502-3939
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-14
Last Update Date:2013-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKR0083172363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner