1326181041 NPI number — MS. BRANDY PRINCE NP-C

Table of content: MS. BRANDY PRINCE NP-C (NPI 1326181041)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326181041 NPI number — MS. BRANDY PRINCE NP-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PRINCE
Provider First Name:
BRANDY
Provider Middle Name:
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
NP-C
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1326181041
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/18/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
620 N KIMBALL AVE
Provider Second Line Business Mailing Address:
SUITE 100
Provider Business Mailing Address City Name:
SOUTHLAKE
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76092
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
817-328-8376
Provider Business Mailing Address Fax Number:
817-328-8379

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1207 ARISTA DRIVE
Provider Second Line Business Practice Location Address:
SUITE 103
Provider Business Practice Location Address City Name:
ROCKWALL
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75032
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
469-402-1877
Provider Business Practice Location Address Fax Number:
469-402-1969
Provider Enumeration Date:
02/14/2007

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: 163WG0000X , with the licence number:  658153 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 658153 . This is a "RN" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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