MEDICARE: BRANDI AVILA

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	363L00000X	Nurse Practitioner	1154298	TX
2	363LF0000X	Family Nurse Practitioner	1154298	TX

General Provider Information

NPI Number	:	1811755846
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRANDI AVILA

Provider Business Mailing Address
First Line	:	3608 CALVIN ST
Second Line	:
City	:	BIG SPRING
State	:	TX
Zip	:	79720-6806
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3608 CALVIN ST
Second Line	:
City	:	BIG SPRING
State	:	TX
Zip	:	79720-6806
Country	:	US
Telephone Number	:	432-270-1039
Fax Number	:

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

Provider Enumeration Date	:	03/13/2024
Last Update Date	:	05/01/2026

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Directions to “ BRANDI AVILA ” Practice Location

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