Provider Demographics
NPI:1477746758
Name:LIBBY, BRANDY L (WHNP)
Entity Type:Individual
Prefix:
First Name:BRANDY
Middle Name:L
Last Name:LIBBY
Suffix:
Gender:F
Credentials:WHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1908 N LAURENT ST STE 410
Mailing Address - Street 2:
Mailing Address - City:VICTORIA
Mailing Address - State:TX
Mailing Address - Zip Code:77901-5469
Mailing Address - Country:US
Mailing Address - Phone:361-572-0333
Mailing Address - Fax:361-371-7090
Practice Address - Street 1:3800 S W S YOUNG DR STE 402
Practice Address - Street 2:
Practice Address - City:KILLEEN
Practice Address - State:TX
Practice Address - Zip Code:76542-3374
Practice Address - Country:US
Practice Address - Phone:254-618-4960
Practice Address - Fax:254-618-4965
Is Sole Proprietor?:No
Enumeration Date:2007-08-21
Last Update Date:2019-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP112339363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1908030-04Medicaid
TX1908030-02Medicaid
TXAP112339OtherLICENSE
TX642593OtherLICENSE