Healthcare Provider Details

I. General information

NPI: 1043968035
Provider Name (Legal Business Name): BRIANNA MEBANE FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/17/2022
Last Update Date: 11/06/2024
Certification Date: 11/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4613 S STAPLES ST STE C&D
CORPUS CHRISTI TX
78411-2780
US

IV. Provider business mailing address

7634 DOVE HOLLOW DR
CORPUS CHRISTI TX
78414-4478
US

V. Phone/Fax

Practice location:
  • Phone: 361-851-0000
  • Fax:
Mailing address:
  • Phone: 361-947-1919
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number1041041
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number1041041
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: