Provider Demographics
NPI:1477636009
Name:BRIGHAM, BERYL ANN (ACNP-BC)
Entity Type:Individual
Prefix:
First Name:BERYL
Middle Name:ANN
Last Name:BRIGHAM
Suffix:
Gender:F
Credentials:ACNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2078
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:TX
Mailing Address - Zip Code:76234-6156
Mailing Address - Country:US
Mailing Address - Phone:940-249-9009
Mailing Address - Fax:940-626-8684
Practice Address - Street 1:2014 BEN MERRITT DR
Practice Address - Street 2:SUITE A
Practice Address - City:DECATUR
Practice Address - State:TX
Practice Address - Zip Code:76234-3850
Practice Address - Country:US
Practice Address - Phone:940-249-9009
Practice Address - Fax:940-626-8684
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2017-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP115429363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8613NZOtherBCBS
TX366546501Medicaid
TX318386YLH5Medicare PIN