MEDICARE: BREANNA M WHEELER

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	106S00000X	Behavior Technician		TX

General Provider Information

NPI Number	:	1316886179
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BREANNA M WHEELER

Provider Business Mailing Address
First Line	:	2941 EDGERTON RD
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76179-2289
Country	:	US
Telephone Number	:	682-209-9793
Fax Number	:	682-209-9793

Provider Business Practice Location Address
First Line	:	2941 EDGERTON RD
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76179-2289
Country	:	US
Telephone Number	:	682-209-9793
Fax Number	:	682-209-9793

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

Provider Enumeration Date	:	03/26/2026
Last Update Date	:	03/26/2026

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Directions to “ BREANNA M WHEELER ” Practice Location

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