Provider Demographics
NPI:1346560976
Name:BANNER, BRANDI BRIANNE (LMT,CMMT,MTI)
Entity Type:Individual
Prefix:
First Name:BRANDI
Middle Name:BRIANNE
Last Name:BANNER
Suffix:
Gender:F
Credentials:LMT,CMMT,MTI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4200 ARDEN RD
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79110-4102
Mailing Address - Country:US
Mailing Address - Phone:806-477-2111
Mailing Address - Fax:
Practice Address - Street 1:3706 MOCKINGBIRD LN
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79109-3208
Practice Address - Country:US
Practice Address - Phone:806-477-2111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-05
Last Update Date:2010-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMT102494174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist