Healthcare Provider Details

I. General information

NPI: 1962373803
Provider Name (Legal Business Name): FIREWHEEL TELEMEDICINE, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/15/2025
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4031 112TH ST
LUBBOCK TX
79423-6749
US

IV. Provider business mailing address

4031 112TH ST
LUBBOCK TX
79423-6749
US

V. Phone/Fax

Practice location:
  • Phone: 817-767-0922
  • Fax: 480-588-3093
Mailing address:
  • Phone: 817-767-0922
  • Fax: 480-588-3093

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084B0002X
TaxonomyObesity Medicine (Psychiatry & Neurology) Physician
License Number
License Number State

VIII. Authorized Official

Name: KATIE BRANDON
Title or Position: OWNER, FOUNDER, PROVIDER
Credential: APRN
Phone: 817-767-0922