Provider Demographics
NPI:1881188332
Name:ABRY MEDICAL PLLC
Entity Type:Organization
Organization Name:ABRY MEDICAL PLLC
Other - Org Name:GRACE MEDICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRANDY
Authorized Official - Middle Name:M
Authorized Official - Last Name:ROBERTS
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-BC
Authorized Official - Phone:936-391-5606
Mailing Address - Street 1:PO BOX M
Mailing Address - Street 2:
Mailing Address - City:HULL
Mailing Address - State:TX
Mailing Address - Zip Code:77564-0715
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7655 FM 834
Practice Address - Street 2:
Practice Address - City:HULL
Practice Address - State:TX
Practice Address - Zip Code:77564
Practice Address - Country:US
Practice Address - Phone:936-536-6057
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-19
Last Update Date:2018-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP120895363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty