Individual
BRANDY FULTZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
6223 N 129TH EAST AVE, OWASSO, OK 74055-7536
(918) 671-1567
Mailing address
6223 N 129TH EAST AVE, OWASSO, OK 74055-7536
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
—
—
Other
Enumeration date
06/29/2026
Last updated
06/29/2026
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