Provider Demographics
NPI:1477661023
Name:BRACKLEY, MARY MARGARET (PHD, APRN, BC)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:MARGARET
Last Name:BRACKLEY
Suffix:
Gender:F
Credentials:PHD, APRN, BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31144 SIERRA VISTA DR
Mailing Address - Street 2:
Mailing Address - City:BULVERDE
Mailing Address - State:TX
Mailing Address - Zip Code:78163-4590
Mailing Address - Country:US
Mailing Address - Phone:210-567-3809
Mailing Address - Fax:210-567-5822
Practice Address - Street 1:8109 FREDERICKSBURG RD
Practice Address - Street 2:PSYCHIATRIC CONSULTATION SERVICES
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-3311
Practice Address - Country:US
Practice Address - Phone:210-575-0508
Practice Address - Fax:210-575-0501
Is Sole Proprietor?:No
Enumeration Date:2006-08-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX445268363LF0000X, 364SP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Not Answered364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult
Provider Identifiers
StateIdentifier IDID TypeIssuer
8C8954Medicare ID - Type Unspecified
TX3 Q31281Medicare UPIN