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General NPI Number Information
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NPI Number | 1740077155
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Entity Type | Individual
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Provider Name | BRANDON DEMOND WYRICK
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Gender | Male
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Dates
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Enumeration Date | 04/21/2025
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Last Update Date | 01/16/2026
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Provider Practice Location Address
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Address Line | 3 MORROW DR
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City | BEDFORD
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State | TX
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Zip | 76021-5675
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Country | US
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Telephone | 903-314-8459
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 6435
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City | TEXARKANA
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State | TX
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Zip | 75505-6435
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Country | US
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Telephone | 903-314-8459
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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 | 174H00000X
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Taxonomy Name | Health Educator
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number |
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License Number State |
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Taxonomy #3
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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 |
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Taxonomy #4
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Taxonomy Code | 261QR0800X
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Taxonomy Name | Recovery Care Clinic/Center
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License Number |
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License Number State | TX
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Taxonomy #5
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Taxonomy Code | 373H00000X
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Taxonomy Name | Day Training/Habilitation Specialist
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 372600000X
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Taxonomy Name | Adult Companion
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 251J00000X
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Taxonomy Name | Nursing Care Agency
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License Number |
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License Number State |
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Taxonomy #8
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Taxonomy Code | 374U00000X
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Taxonomy Name | Home Health Aide
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License Number |
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License Number State |
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Taxonomy #9
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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Taxonomy #10
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number |
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License Number State |
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