=====================================================
General NPI Number Information
=====================================================
NPI Number | 1639984347
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | B.A.D. BRUCE, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/10/2025
-----------------------------------------------------
Last Update Date | 02/10/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 707 S COLORADO ST
-----------------------------------------------------
City | WHITNEY
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76692-2826
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 254-485-0108
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 707 S COLORADO ST
-----------------------------------------------------
City | WHITNEY
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76692-2826
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 254-485-0108
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | FNP-C/OWNER
-----------------------------------------------------
Name | MELLISSA MAY BRUCE
-----------------------------------------------------
Credential | FNP-C
-----------------------------------------------------
Telephone | 254-485-0108
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QP2300X
-----------------------------------------------------
Taxonomy Name | Primary Care Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------