Provider Demographics
NPI:1952492209
Name:YEARY, BRANDY LYNNETTE (MD)
Entity Type:Individual
Prefix:DR
First Name:BRANDY
Middle Name:LYNNETTE
Last Name:YEARY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1900 MATLOCK RD STE 804
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76063
Mailing Address - Country:US
Mailing Address - Phone:682-800-3211
Mailing Address - Fax:682-422-7660
Practice Address - Street 1:1900 MATLOCK RD STE 804
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:TX
Practice Address - Zip Code:76063
Practice Address - Country:US
Practice Address - Phone:682-800-3211
Practice Address - Fax:682-422-7660
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2022-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK35224207Q00000X
NC2019-02554207Q00000X
MO2019044234207Q00000X
MA281818207Q00000X
ARE-12711207Q00000X
TXM2874207Q00000X
LA321518207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8EF273OtherBLUE CROSS AND BLUE SHIELD OF TEXAS
TX284150402Medicaid
TX651675YKQJMedicare PIN