Healthcare Provider Details

I. General information

NPI: 1952492209
Provider Name (Legal Business Name): BRANDY LYNNETTE YEARY M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2006
Last Update Date: 10/14/2022
Certification Date: 10/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 MATLOCK RD STE 804
MANSFIELD TX
76063
US

IV. Provider business mailing address

1900 MATLOCK RD STE 804
MANSFIELD TX
76063
US

V. Phone/Fax

Practice location:
  • Phone: 682-800-3211
  • Fax: 682-422-7660
Mailing address:
  • Phone: 682-800-3211
  • Fax: 682-422-7660

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number35224
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2019-02554
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2019044234
License Number StateMO
# 4
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number281818
License Number StateMA
# 5
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberE-12711
License Number StateAR
# 6
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberM2874
License Number StateTX
# 7
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number321518
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: