Active NPI
Marquita Tavisia Brown
- Peer Specialist
- Ardmore, OK
National Provider Identifier
1821715210
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Peer Specialist
- Practice address
- 1105 E St NW
Ardmore, OK 73401-4267 - Phone
- (580) 630-4089
- NPI assigned
- Oct 26, 2022
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Behavior Technician | 106S00000X | |||
| Peer Specialist | 175T00000X | Primary |
Addresses
Primary practice location
1105 E St NW
Ardmore, OK 73401-4267
Mailing address
1105 E St NW
Ardmore, OK 73401-4267
Phone (580) 630-4089
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| A926225446 | Other | OK | OKLAHOMA DEPARTMENT OF PUBLIC SAFETY |
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
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1666742400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1669852800000",
"number": "1821715210",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1105 E ST NW",
"city": "ARDMORE",
"state": "OK",
"postal_code": "734014267",
"telephone_number": "580-630-4089"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1105 E ST NW",
"city": "ARDMORE",
"state": "OK",
"postal_code": "734014267",
"telephone_number": "580-630-4089"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BROWN",
"first_name": "MARQUITA",
"middle_name": "TAVISIA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2022-10-26",
"last_updated": "2022-12-01",
"certification_date": "2022-12-01",
"status": "A"
},
"taxonomies": [
{
"code": "106S00000X",
"taxonomy_group": "",
"desc": "Behavior Technician",
"state": null,
"license": null,
"primary": false
},
{
"code": "175T00000X",
"taxonomy_group": "",
"desc": "Peer Specialist",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "OKLAHOMA DEPARTMENT OF PUBLIC SAFETY",
"identifier": "A926225446",
"state": "OK"
}
],
"endpoints": [],
"other_names": []
}Other providers in Ardmore, OK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 1, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.