Healthcare Provider Details

I. General information

NPI: 1427690320
Provider Name (Legal Business Name): BREANN TNAE POOL ST
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: BREANN TNAE BARNETT

II. Dates (important events)

Enumeration Date: 10/11/2019
Last Update Date: 10/14/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3501 S SONCY RD STE 137
AMARILLO TX
79119-6406
US

IV. Provider business mailing address

8726 LUPINE
AMARILLO TX
79119-1189
US

V. Phone/Fax

Practice location:
  • Phone: 806-331-6084
  • Fax:
Mailing address:
  • Phone: 806-331-6084
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: