MEDICARE: B & B COMMUNITY IMPACT CENTER

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	363LF0000X	Family Nurse Practitioner

General Provider Information

NPI Number	:	1013587542
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	B & B COMMUNITY IMPACT CENTER

Provider Business Mailing Address
First Line	:	1438 OXBOW DR
Second Line	:
City	:	CEDAR HILL
State	:	TX
Zip	:	75104-4006
Country	:	US
Telephone Number	:	504-251-0493
Fax Number	:

Provider Business Practice Location Address
First Line	:	1438 OXBOW DR
Second Line	:
City	:	CEDAR HILL
State	:	TX
Zip	:	75104-4006
Country	:	US
Telephone Number	:	504-251-0493
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	BRANDI BURNETT
Credential	:	FNP
Telephone Number	:	903-805-8788

Provider Enumeration Date	:	06/28/2021
Last Update Date	:	06/28/2021

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Directions to “B & B COMMUNITY IMPACT CENTER ” Practice Location

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