1528299690 NPI number — BRANDY VALENTINE LEBLANC DACM

Table of content: BRANDY VALENTINE LEBLANC DACM (NPI 1528299690)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528299690 NPI number — BRANDY VALENTINE LEBLANC DACM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LEBLANC
Provider First Name:
BRANDY
Provider Middle Name:
VALENTINE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DACM
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
LEBLANC
Provider Other First Name:
BRANDY
Provider Other Middle Name:
VALENTINE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
DACM
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1528299690
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/10/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9717 E 42ND ST STE 130
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TULSA
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
74146-3677
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
539-250-9959
Provider Business Mailing Address Fax Number:
918-928-3606

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9717 E 42ND ST STE 130
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TULSA
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
74146-3677
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
187-030-7249
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/06/2009

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 171100000X , with the licence number:  021586 , registered in the state of OK ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 171100000X , with the licence number: 2013007120 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 171100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)