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General NPI Number Information
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NPI Number | 1316461320
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Entity Type | Individual
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Provider Name | KEOSHA BRIGHTMON
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Gender | Female
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Dates
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Enumeration Date | 08/01/2017
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Last Update Date | 12/18/2019
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Provider Practice Location Address
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Address Line | 1221 HIGHVIEW DR
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City | CEDAR HILL
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State | TX
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Zip | 75104-5455
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Country | US
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Telephone | 214-862-5426
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Fax | 214-862-5426
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Provider Business Mailing Address
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Address Line | 1221 HIGHVIEW DR
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City | CEDAR HILL
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State | TX
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Zip | 75104-5455
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Country | US
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Telephone | 214-862-5426
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Fax | 972-502-9181
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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 | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State | TX
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