Provider Demographics
NPI:1215536271
Name:BRAZELTON, KATHRYN (FNP)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:
Last Name:BRAZELTON
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6402 DREWFALLS DR
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77407-5561
Mailing Address - Country:US
Mailing Address - Phone:281-428-6459
Mailing Address - Fax:
Practice Address - Street 1:636 S PEEK RD
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77450-3186
Practice Address - Country:US
Practice Address - Phone:832-437-7239
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-21
Last Update Date:2022-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF10200575208000000X
TX10200575363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No208000000XAllopathic & Osteopathic PhysiciansPediatrics