Brian Keith Wilbourn

Primary specialty

Peer SpecialistTaxonomy code 175T00000X

Practice address

32018 Hwy 59-Ok
Maud, OK 74854

Phone

(405) 374-1225

Fax

(866) 201-3530

NPI assigned

Jul 7, 2023

Last updated

Jul 7, 2023By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Practice roles

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

• Clay Crossing Foundation

  • Substance Abuse Rehabilitation Facility
  • Maud, OK
  • NPI 1114332442
  NPD (past)
• Clay Crossing Foundation Inc

  • Community/Behavioral Health Agency
  • Maud, OK
  • NPI 1508999319
  NPD (past)

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

{
    "created_epoch": "1688688000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1688688000000",
    "number": "1811675002",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 8",
            "city": "MAUD",
            "state": "OK",
            "postal_code": "748540008",
            "telephone_number": "405-374-1225",
            "fax_number": "866-201-3530"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "32018 HWY 59-OK",
            "city": "MAUD",
            "state": "OK",
            "postal_code": "74854",
            "telephone_number": "405-374-1225",
            "fax_number": "866-201-3530"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILBOURN",
        "first_name": "BRIAN",
        "middle_name": "KEITH",
        "name_prefix": "Mr.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-07-07",
        "last_updated": "2023-07-07",
        "certification_date": "2023-06-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "175T00000X",
            "taxonomy_group": "",
            "desc": "Peer Specialist",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Wendi Nichole Sheffield, M.S. CCC-SLP
• William O Taylor II
• Brandon Dean Trimble
• Haley Chrisine Waltman
• Kelis Ayn Whisenhunt, MA, LPC, CADC
• Stephen Andrew Wolfe

• Peer Specialist in Maud, OK
• Providers in Maud, OK by specialty
• Peer Specialist in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 7, 2023; 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.