Provider Demographics
NPI:1699418970
Name:THOMASON, BRANDON LEN
Entity type:Individual
Prefix:
First Name:BRANDON
Middle Name:LEN
Last Name:THOMASON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 S VANN ST
Mailing Address - Street 2:
Mailing Address - City:PRYOR
Mailing Address - State:OK
Mailing Address - Zip Code:74361-3613
Mailing Address - Country:US
Mailing Address - Phone:918-991-5185
Mailing Address - Fax:
Practice Address - Street 1:16 S VANN ST
Practice Address - Street 2:
Practice Address - City:PRYOR
Practice Address - State:OK
Practice Address - Zip Code:74361-3613
Practice Address - Country:US
Practice Address - Phone:918-991-5185
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-15
Last Update Date:2022-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator