=====================================================
General NPI Number Information
=====================================================
NPI Number | 1346827342
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | BRITTANY KAYE GRAHAM FNP-C
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/25/2021
-----------------------------------------------------
Last Update Date | 10/04/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 120 FARM ROAD 2825
-----------------------------------------------------
City | CLARKSVILLE
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75426-3348
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 903-427-2201
-----------------------------------------------------
Fax | 903-427-3204
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1601 LAMAR AVE
-----------------------------------------------------
City | PARIS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75460-4660
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 903-741-1101
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363L00000X
-----------------------------------------------------
Taxonomy Name | Nurse Practitioner
-----------------------------------------------------
License Number | 1021644
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------