Individual
MISS BRENDA DARLENE JETTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
18414 S HWY 75, MOUNDS, OK 74047-7411
(918) 827-4022
Mailing address
18414 S HWY 75, MOUNDS, OK 74047-7411
(918) 827-4022
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
200063440A
OK
174400000X
Specialist
20063440B
OK
174400000X
Specialist
Primary
20063440C
OK
Other
Enumeration date
05/11/2007
Last updated
07/08/2007
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