Healthcare Provider Details

I. General information

NPI: 1235748880
Provider Name (Legal Business Name): EMILY BROOKE COMBS FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/29/2020
Last Update Date: 08/28/2023
Certification Date: 10/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3300 N A ST STE 110
MIDLAND TX
79705-5421
US

IV. Provider business mailing address

3300 N A ST STE 110
MIDLAND TX
79705-5421
US

V. Phone/Fax

Practice location:
  • Phone: 432-400-3401
  • Fax: 432-400-3402
Mailing address:
  • Phone: 432-400-3401
  • Fax: 432-400-3402

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1004514
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: