Provider Demographics
NPI:1710903778
Name:WELLMON, BRANDY D (MS)
Entity Type:Individual
Prefix:
First Name:BRANDY
Middle Name:D
Last Name:WELLMON
Suffix:
Gender:F
Credentials:MS
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Mailing Address - Street 1:6500 NORTH MOPAC
Mailing Address - Street 2:BLDG. III SUITE 200
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78731
Mailing Address - Country:US
Mailing Address - Phone:512-458-8400
Mailing Address - Fax:512-458-8593
Practice Address - Street 1:6500 NORTH MOPAC
Practice Address - Street 2:BLDG. III SUITE 200
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78731
Practice Address - Country:US
Practice Address - Phone:512-458-8400
Practice Address - Fax:512-458-8593
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXPA04437363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant