Healthcare Provider Details

I. General information

NPI: 1265259089
Provider Name (Legal Business Name): MICHELLE BRAGET PA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/23/2024
Last Update Date: 09/27/2024
Certification Date: 09/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 E H ST
MC COOK NE
69001-3482
US

IV. Provider business mailing address

905 W 5TH ST
MC COOK NE
69001-3016
US

V. Phone/Fax

Practice location:
  • Phone: 308-344-2650
  • Fax:
Mailing address:
  • Phone: 406-868-3723
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number3161
License Number StateNE
# 2
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number3161
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: