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General NPI Number Information
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NPI Number | 1811505688
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Entity Type | Individual
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Provider Name | BRANDY B CLARK
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Gender | Female
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Dates
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Enumeration Date | 07/17/2020
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Last Update Date | 07/17/2020
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Provider Practice Location Address
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Address Line | 11927 SONORA SPRINGS DR
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City | TOMBALL
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State | TX
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Zip | 77375-1760
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Country | US
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Telephone | 832-298-9095
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Fax | 281-310-6576
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Provider Business Mailing Address
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Address Line | PO BOX 682781
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City | HOUSTON
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State | TX
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Zip | 77268-2781
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Country | US
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Telephone |
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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 | 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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