Provider Demographics
NPI:1669777991
Name:BRANNAN, KRISTEN RENE' (PA-C)
Entity type:Individual
Prefix:MRS
First Name:KRISTEN
Middle Name:RENE'
Last Name:BRANNAN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MISS
Other - First Name:KRISTEN
Other - Middle Name:RENE'
Other - Last Name:OGAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:1200 CHILDRENS AVE STE 14500
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73104-4637
Mailing Address - Country:US
Mailing Address - Phone:405-271-5311
Mailing Address - Fax:405-271-3767
Practice Address - Street 1:1200 CHILDRENS AVE STE 14500
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73104-4637
Practice Address - Country:US
Practice Address - Phone:405-271-4412
Practice Address - Fax:405-271-3265
Is Sole Proprietor?:No
Enumeration Date:2011-01-18
Last Update Date:2015-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKPA1977363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical