Brenda Darlene Jetton

Primary specialty

SpecialistTaxonomy code 174400000X

License

20063440C Issued in OK

Practice address

18414 S Hwy 75
Mounds, OK 74047-7411

Phone

(918) 827-4022

NPI assigned

May 11, 2007

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1178841600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1144435405",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "18414 S HWY 75",
            "city": "MOUNDS",
            "state": "OK",
            "postal_code": "740477411",
            "telephone_number": "918-827-4022"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "18414 S HWY 75",
            "city": "MOUNDS",
            "state": "OK",
            "postal_code": "740477411",
            "telephone_number": "918-827-4022"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JETTON",
        "first_name": "BRENDA",
        "middle_name": "DARLENE",
        "name_prefix": "Miss",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-05-11",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "OK",
            "license": "200063440A",
            "primary": false
        },
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "OK",
            "license": "20063440B",
            "primary": false
        },
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "OK",
            "license": "20063440C",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Specialist in Mounds, OK
• Providers in Mounds, OK by specialty
• Specialist in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.