Provider Demographics
NPI:1710647508
Name:BRAWLEY, PRISCILLA (MS, RD)
Entity Type:Individual
Prefix:MRS
First Name:PRISCILLA
Middle Name:
Last Name:BRAWLEY
Suffix:
Gender:F
Credentials:MS, RD
Other - Prefix:
Other - First Name:PRISCILLA
Other - Middle Name:
Other - Last Name:HOLMES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8408 DULL RD
Mailing Address - Street 2:
Mailing Address - City:CLEMMONS
Mailing Address - State:NC
Mailing Address - Zip Code:27012-8091
Mailing Address - Country:US
Mailing Address - Phone:336-469-7362
Mailing Address - Fax:
Practice Address - Street 1:118 HAMBY RD
Practice Address - Street 2:
Practice Address - City:DOBSON
Practice Address - State:NC
Practice Address - Zip Code:27017-8471
Practice Address - Country:US
Practice Address - Phone:336-401-8400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-21
Last Update Date:2021-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCL006584133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered