Healthcare Provider Details

I. General information

NPI: 1780327395
Provider Name (Legal Business Name): BRANDY M BELAVAL FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/20/2022
Last Update Date: 02/12/2024
Certification Date: 09/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 WALLACE BLVD
AMARILLO TX
79106-1799
US

IV. Provider business mailing address

PO BOX 840026
DALLAS TX
75284-0026
US

V. Phone/Fax

Practice location:
  • Phone: 806-212-2000
  • Fax: 806-212-2246
Mailing address:
  • Phone: 806-212-5079
  • Fax: 806-212-6278

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1069536
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: