Provider Demographics
NPI:1760789564
Name:BRAUGHLER, ROBIN LUAN
Entity Type:Individual
Prefix:
First Name:ROBIN
Middle Name:LUAN
Last Name:BRAUGHLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4103 CACTUS DR
Mailing Address - Street 2:
Mailing Address - City:ARGYLE
Mailing Address - State:TX
Mailing Address - Zip Code:76226-6764
Mailing Address - Country:US
Mailing Address - Phone:940-442-8117
Mailing Address - Fax:940-464-0615
Practice Address - Street 1:4103 CACTUS DR
Practice Address - Street 2:
Practice Address - City:ARGYLE
Practice Address - State:TX
Practice Address - Zip Code:76226-6764
Practice Address - Country:US
Practice Address - Phone:940-442-8117
Practice Address - Fax:940-464-0615
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-15
Last Update Date:2011-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
305S00000X, 376J00000X, 376K00000X
TX013968251E00000X, 305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service
No376J00000XNursing Service Related ProvidersHomemaker
No376K00000XNursing Service Related ProvidersNurse's Aide
No251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXS50032930Medicaid