Individual
MR. BRIAN TRAVIS PENDARVIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
ARNP
Contact information
Practice address
205 SOUTH MAIN STREET, NOBLE, OK 73068
(405) 872-5403
(405) 872-5407
Mailing address
205 SOUTH MAIN STREET, PO BOX 2096, NOBLE, OK 73068
(405) 872-5403
(405) 872-5407
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
R0067224
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200043980A
—
OK
Enumeration date
06/20/2005
Last updated
01/30/2014
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