Healthcare Provider Details

I. General information

NPI: 1023437167
Provider Name (Legal Business Name): NICCI OWUSU-BRACKETT M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/15/2014
Last Update Date: 11/13/2025
Certification Date: 11/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7979 WURZBACH RD
SAN ANTONIO TX
78229-4427
US

IV. Provider business mailing address

7979 WURZBACH RD
SAN ANTONIO TX
78229-4427
US

V. Phone/Fax

Practice location:
  • Phone: 210-450-5990
  • Fax: 210-450-1747
Mailing address:
  • Phone: 210-450-5990
  • Fax: 210-450-1747

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberR0774
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License NumberR0774
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: