Individual
BRYAN MARSHALL TISON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PNP-PC
Contact information
Practice address
2000 E 15TH ST STE 400A, EDMOND, OK 73013-6673
(405) 341-1697
(405) 341-2672
Mailing address
2000 E 15TH ST STE 400A, EDMOND, OK 73013-6673
(405) 341-1697
(405) 341-2672
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
101670
OK
Other
Enumeration date
10/02/2017
Last updated
07/21/2022
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