Provider Demographics
NPI:1649221169
Name:BROWN-TRASK, BETTY JEAN (PNP-BC, FNP-C)
Entity Type:Individual
Prefix:MS
First Name:BETTY
Middle Name:JEAN
Last Name:BROWN-TRASK
Suffix:
Gender:F
Credentials:PNP-BC, FNP-C
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 660599
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75266-0599
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3310 LIVE OAK ST
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75204-6153
Practice Address - Country:US
Practice Address - Phone:214-266-1257
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2022-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX524863363LP0200X
TXAP102205363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8Y0761OtherBLUE CROSS BLUE SHIELD
TX108059003Medicaid
TX108059008Medicaid
TX108059007Medicaid
TX108059008Medicaid
TX8Y0761OtherBLUE CROSS BLUE SHIELD
TXS82417Medicare UPIN