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NPI Code Detail

MEDICARE: BRANDY NICHOLE GRAHAM FNP

MEDICARE: BRANDY NICHOLE GRAHAM FNP
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
1363LF0000XFamily Nurse Practitioner735423TX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1780925396
Entity Type Code : Individual
Provider Name (Legal Business Name) : BRANDY NICHOLE GRAHAM FNP
Provider Business Mailing Address
First Line : 851 HIGHWAY 287 N
Second Line :
City : MANSFIELD
State : TX
Zip : 76063-2664
Country : US
Telephone Number : 817-842-2500
Fax Number : 817-842-2599
Provider Business Practice Location Address
First Line : 6363 N STATE HIGHWAY 161 STE 100
Second Line :
City : IRVING
State : TX
Zip : 75038-2239
Country : US
Telephone Number : 469-200-3272
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/06/2013
Last Update Date : 02/21/2023

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