Active NPI
Brandon Crosthwait, BSRT RDMS RVT RDCS
- Technician/Technologist
- Shawnee, OK
National Provider Identifier
1811743586
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Technician/Technologist
- License
- 103654
- Practice address
- 3315 Kethley Rd
Shawnee, OK 74804-9638 - Phone
- (405) 273-5801
- NPI assigned
- Apr 24, 2024
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Technician/Technologist | 156F00000X | 103654 | OK | Primary |
Addresses
Primary practice location
3315 Kethley Rd
Shawnee, OK 74804-9638
Mailing address
3315 Kethley Rd
Shawnee, OK 74804-9638
Phone (405) 273-5801
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 103654 | OK | MD | Family Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1713916800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1713916800000",
"number": "1811743586",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3315 KETHLEY RD",
"city": "SHAWNEE",
"state": "OK",
"postal_code": "748049638",
"telephone_number": "405-273-5801"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3315 KETHLEY RD",
"city": "SHAWNEE",
"state": "OK",
"postal_code": "748049638",
"telephone_number": "405-273-5801"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CROSTHWAIT",
"first_name": "BRANDON",
"name_prefix": "Mr.",
"credential": "BSRT RDMS RVT RDCS",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2024-04-24",
"last_updated": "2024-04-24",
"certification_date": "2024-04-24",
"status": "A"
},
"taxonomies": [
{
"code": "156F00000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Technician/Technologist",
"state": "OK",
"license": "103654",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Shawnee, OK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 24, 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.