Healthcare Provider Details

I. General information

NPI: 1932411816
Provider Name (Legal Business Name): MEGAN K BRADY CPNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/08/2010
Last Update Date: 01/28/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1935 MEDICAL DISTRICT DR
DALLAS TX
75235-7701
US

IV. Provider business mailing address

6904 CLEMSON DR
DALLAS TX
75214-1713
US

V. Phone/Fax

Practice location:
  • Phone: 214-456-7008
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0222X
TaxonomyCritical Care Pediatric Nurse Practitioner
License Number132825
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: