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General NPI Number Information
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NPI Number | 1144515578
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Entity Type | Individual
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Provider Name | BRENDA S MALLETT NP
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Gender | Female
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Dates
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Enumeration Date | 06/14/2011
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Last Update Date | 02/05/2014
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Provider Practice Location Address
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Address Line | 10435 GREENBOUGH DR STE 300
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City | STAFFORD
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State | TX
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Zip | 77477-5034
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Country | US
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Telephone | 281-261-0182
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Fax |
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Provider Business Mailing Address
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Address Line | 400 AUSTIN ST
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City | RICHMOND
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State | TX
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Zip | 77469-4406
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Country | US
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Telephone | 281-342-4530
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number | 1440
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License Number State | TX
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