Texoma Collaborative Family Medicine LLC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

TEXOMA COLLABORATIVE FAMILY MEDICINE LLC

Practice address

1005 15TH Ave NW
Ardmore, OK 73401-1810

Phone

(580) 798-5015

NPI assigned

Mar 21, 2024

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Jessy Bracklein

Title

Owner

Phone

(580) 798-5015

Specialties & licenses 1

Addresses

Other identifiers 1

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1710979200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1710979200000",
    "number": "1083474522",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1005 15TH AVE NW",
            "city": "ARDMORE",
            "state": "OK",
            "postal_code": "734011810",
            "telephone_number": "580-798-5015"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1005 15TH AVE NW",
            "city": "ARDMORE",
            "state": "OK",
            "postal_code": "734011810",
            "telephone_number": "580-798-5015"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TEXOMA COLLABORATIVE FAMILY MEDICINE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-03-21",
        "last_updated": "2024-03-21",
        "certification_date": "2024-03-21",
        "status": "A",
        "authorized_official_last_name": "BRACKLEIN",
        "authorized_official_first_name": "JESSY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "580-798-5015"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200294340A",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Donna Taylor
• Keri Taylor, LPC
• Krystle Taylor
• Mary Dwayna Temple Goins, DDS
• John Medwin Terry Jr.
• Texoma Psychology Group, PLLC
• Amanda Gail Thacker
• Deana Marie Tharp, M.ED, LPC
• Rachelle Tharp
• Loyd Elliott Thayer, MD

• Family Medicine Physician in Ardmore, OK
• Providers in Ardmore, OK by specialty
• Family Medicine Physician in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 21, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.