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General NPI Number Information
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NPI Number | 1962385187
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Entity Type | Individual
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Provider Name | BRIAN MCDONOUGH APRN-CNP
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Gender | Male
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Dates
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Enumeration Date | 07/26/2025
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Last Update Date | 07/26/2025
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Provider Practice Location Address
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Address Line | 346 MARINE FORCES DR
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City | GRAND PRAIRIE
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State | TX
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Zip | 75051-2412
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Country | US
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Telephone | 202-598-3411
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Fax |
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Provider Business Mailing Address
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Address Line | 427 ALEX DR
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City | COPPELL
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State | TX
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Zip | 75019-2944
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Country | US
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Telephone | 713-922-6910
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | AP119744
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License Number State | TX
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