Provider Demographics
NPI:1407678006
Name:JAYNE, BRANITA DAWN
Entity type:Individual
Prefix:
First Name:BRANITA
Middle Name:DAWN
Last Name:JAYNE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:BRANITA
Other - Middle Name:DAWN
Other - Last Name:BRAND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2660 S LUTHER RD
Mailing Address - Street 2:
Mailing Address - City:HARRAH
Mailing Address - State:OK
Mailing Address - Zip Code:73045-6368
Mailing Address - Country:US
Mailing Address - Phone:405-823-7214
Mailing Address - Fax:
Practice Address - Street 1:4401 W MEMORIAL RD STE 143
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73134-1787
Practice Address - Country:US
Practice Address - Phone:405-486-8600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-26
Last Update Date:2024-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2382427163WH0200X
OR10025322163WH0200X
OKR0091363163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health