MEDICARE: BRANDON DEMOND WYRICK

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number State
1	174H00000X	Health Educator
2	103K00000X	Behavior Analyst
3	251S00000X	Community/Behavioral Health Agency
4	261QR0800X	Recovery Care Clinic/Center	TX
5	373H00000X	Day Training/Habilitation Specialist
6	372600000X	Adult Companion
7	251J00000X	Nursing Care Agency
8	374U00000X	Home Health Aide
9	251E00000X	Home Health Agency
10	261QH0100X	Health Service Clinic/Center

General Provider Information

NPI Number	:	1740077155
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRANDON DEMOND WYRICK

Provider Business Mailing Address
First Line	:	PO BOX 6435
Second Line	:
City	:	TEXARKANA
State	:	TX
Zip	:	75505-6435
Country	:	US
Telephone Number	:	903-314-8459
Fax Number	:

Provider Business Practice Location Address
First Line	:	3 MORROW DR
Second Line	:
City	:	BEDFORD
State	:	TX
Zip	:	76021-5675
Country	:	US
Telephone Number	:	903-314-8459
Fax Number	:

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

Provider Enumeration Date	:	04/21/2025
Last Update Date	:	01/16/2026

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