MEDICARE: NICOLE ANN BRAY PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	PA04796	TX

General Provider Information

NPI Number	:	1013050533
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICOLE ANN BRAY PA-C

Provider Business Mailing Address
First Line	:	2340 E TRINITY MILLS RD STE 250
Second Line	:
City	:	CARROLLTON
State	:	TX
Zip	:	75006-1946
Country	:	US
Telephone Number	:	972-417-8937
Fax Number	:	972-439-1977

Provider Business Practice Location Address
First Line	:	2720 WESTERN CENTER BLVD STE 312
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76131-4302
Country	:	US
Telephone Number	:	855-893-5637
Fax Number	:	817-666-3873

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/14/2007
Last Update Date	:	10/28/2024

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