MEDICARE: BRANDY EARL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	172V00000X	Community Health Worker

General Provider Information

NPI Number	:	1023754363
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRANDY EARL

Provider Business Mailing Address
First Line	:	1801 TURTLEDOVE DR
Second Line	:
City	:	LITTLE ELM
State	:	TX
Zip	:	75068-8510
Country	:	US
Telephone Number	:	817-726-9649
Fax Number	:

Provider Business Practice Location Address
First Line	:	1801 TURTLEDOVE DR
Second Line	:
City	:	LITTLE ELM
State	:	TX
Zip	:	75068-8510
Country	:	US
Telephone Number	:	817-726-9649
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/10/2022
Last Update Date	:	05/10/2022

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Directions to “ BRANDY EARL ” Practice Location

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