Healthcare Provider Details

I. General information

NPI: 1063816585
Provider Name (Legal Business Name): JUDITH BRANDON FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/13/2014
Last Update Date: 04/24/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6641 GRAND BLVD.
HOUSTON TX
77021
US

IV. Provider business mailing address

6641 GRAND BLVD.
HOUSTON TX
77021
US

V. Phone/Fax

Practice location:
  • Phone: 832-308-1010
  • Fax: 832-308-1017
Mailing address:
  • Phone: 832-308-1010
  • Fax: 832-308-1017

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP126291
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: