Provider Demographics
NPI:1326181041
Name:PRINCE, BRANDY (NP-C)
Entity Type:Individual
Prefix:MS
First Name:BRANDY
Middle Name:
Last Name:PRINCE
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:620 N KIMBALL AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SOUTHLAKE
Mailing Address - State:TX
Mailing Address - Zip Code:76092
Mailing Address - Country:US
Mailing Address - Phone:817-328-8376
Mailing Address - Fax:817-328-8379
Practice Address - Street 1:1207 ARISTA DRIVE
Practice Address - Street 2:SUITE 103
Practice Address - City:ROCKWALL
Practice Address - State:TX
Practice Address - Zip Code:75032
Practice Address - Country:US
Practice Address - Phone:469-402-1877
Practice Address - Fax:469-402-1969
Is Sole Proprietor?:No
Enumeration Date:2007-02-14
Last Update Date:2016-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX658153163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX658153OtherRN