Organization
TEXOMA COLLABORATIVE FAMILY MEDICINE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JESSY BRACKLEIN (OWNER)
(580) 798-5015
Entity
Organization
Contact information
Practice address
1005 15TH AVE NW, ARDMORE, OK 73401-1810
(580) 798-5015
Mailing address
1005 15TH AVE NW, ARDMORE, OK 73401-1810
(580) 798-5015
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200294340A
—
OK
Enumeration date
03/21/2024
Last updated
03/21/2024
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