MEDICARE: CONNIE JO BRAYBROOK PMHNP

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	21142	CA

General Provider Information

NPI Number	:	1053685925
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CONNIE JO BRAYBROOK PMHNP

Provider Business Mailing Address
First Line	:	4301 JONES BRIDGE RD
Second Line	:
City	:	BETHESDA
State	:	MD
Zip	:	20814-4799
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4301 JONES BRIDGE RD
Second Line	:
City	:	BETHESDA
State	:	MD
Zip	:	20814-4712
Country	:	US
Telephone Number	:	301-295-1025
Fax Number	:

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

Provider Enumeration Date	:	02/23/2012
Last Update Date	:	01/21/2026

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