Provider Demographics
NPI:1598522377
Name:BRAGG, CHANDLER (APRN)
Entity Type:Individual
Prefix:
First Name:CHANDLER
Middle Name:
Last Name:BRAGG
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1514 ELM ST APT 402
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75201-3509
Mailing Address - Country:US
Mailing Address - Phone:940-781-4977
Mailing Address - Fax:
Practice Address - Street 1:1514 ELM ST APT 402
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75201-3509
Practice Address - Country:US
Practice Address - Phone:940-781-4977
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-28
Last Update Date:2024-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1151876363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care