Laura S Brandvik, LPN

Primary specialty

Licensed Practical NurseTaxonomy code 164W00000X

License

0056276 Issued in OK

Practice address

PO Box 1
Fort Supply, OK 73841-0001

Phone

(580) 766-2311

NPI assigned

Jan 18, 2018

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Laura S Ray Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Northwest Center for Behavioral Health

  • Institutional Pharmacy
  • Fort Supply, OK
  • NPI 1710174107
  NPD (past)

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

{
    "created_epoch": "1516233600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1516233600000",
    "number": "1669980173",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "52075 S COUNTY ROAD 199",
            "city": "WOODWARD",
            "state": "OK",
            "postal_code": "738015693",
            "telephone_number": "580-374-2615"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "PO BOX 1",
            "city": "FORT SUPPLY",
            "state": "OK",
            "postal_code": "738410001",
            "telephone_number": "580-766-2311"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRANDVIK",
        "first_name": "LAURA",
        "middle_name": "S",
        "credential": "LPN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-01-18",
        "last_updated": "2018-01-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "164W00000X",
            "taxonomy_group": "",
            "desc": "Licensed Practical Nurse",
            "state": "OK",
            "license": "0056276",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "LAURA",
            "last_name": "RAY",
            "middle_name": "S",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Ericka Burleson
• Baylee Taylor Chance
• Fort Supply Public Schools
• Cathy Heinen
• Patrick Scott Herd, MD

• Licensed Practical Nurse in Fort Supply, OK
• Providers in Fort Supply, OK by specialty
• Licensed Practical Nurse in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 18, 2018; 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.