Healthcare Provider Details

I. General information

NPI: 1487532875
Provider Name (Legal Business Name): BRANDON WADE MESSAMORE MSN, APRN, FNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2025
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 LAFFERTY AVE STE B
CAMERON TX
76520-3685
US

IV. Provider business mailing address

101 LAFFERTY AVE STE B
CAMERON TX
76520-3685
US

V. Phone/Fax

Practice location:
  • Phone: 254-605-1100
  • Fax:
Mailing address:
  • Phone: 254-605-1100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number1175334
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1166682
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number1166682
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: