MEDICARE: BRITTANY MANOR

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	163W00000X	Registered Nurse	887998	TX
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	AP145932	TX

General Provider Information

NPI Number	:	1417449356
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRITTANY MANOR

Provider Business Mailing Address
First Line	:	12808 W AIRPORT BLVD STE 275L
Second Line	:
City	:	SUGAR LAND
State	:	TX
Zip	:	77478-6245
Country	:	US
Telephone Number	:	832-210-3868
Fax Number	:	404-420-2615

Provider Business Practice Location Address
First Line	:	12808 W AIRPORT BLVD STE 275L
Second Line	:
City	:	SUGAR LAND
State	:	TX
Zip	:	77478-6245
Country	:	US
Telephone Number	:	832-210-3868
Fax Number	:	404-420-2615

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

Provider Enumeration Date	:	06/06/2018
Last Update Date	:	03/06/2025

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Directions to “ BRITTANY MANOR ” Practice Location

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