MEDICARE: BRANDY LIGHTFOOT

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	163WL0100X	Lactation Consultant (Registered Nurse)	738578	TX

General Provider Information

NPI Number	:	1467041673
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRANDY LIGHTFOOT

Provider Business Mailing Address
First Line	:	26506 PRAIRIE SCHOOL LN
Second Line	:
City	:	KATY
State	:	TX
Zip	:	77494-3681
Country	:	US
Telephone Number	:	832-633-0719
Fax Number	:

Provider Business Practice Location Address
First Line	:	3100 RICHMOND AVE STE 401
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77098-3015
Country	:	US
Telephone Number	:	281-305-0411
Fax Number	:

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

Provider Enumeration Date	:	01/12/2021
Last Update Date	:	01/12/2021

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Directions to “ BRANDY LIGHTFOOT ” Practice Location

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