Provider Demographics
NPI:1356375364
Name:WYRICK, BRENDA L (NURSE PRACTIONER-FAM)
Entity type:Individual
Prefix:
First Name:BRENDA
Middle Name:L
Last Name:WYRICK
Suffix:
Gender:F
Credentials:NURSE PRACTIONER-FAM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:141 RVG PKWY STE 101
Mailing Address - Street 2:
Mailing Address - City:WAXAHACHIE
Mailing Address - State:TX
Mailing Address - Zip Code:75165-5289
Mailing Address - Country:US
Mailing Address - Phone:972-923-8923
Mailing Address - Fax:888-339-3357
Practice Address - Street 1:141 RVG PKWY STE 104
Practice Address - Street 2:
Practice Address - City:WAXAHACHIE
Practice Address - State:TX
Practice Address - Zip Code:75165-5288
Practice Address - Country:US
Practice Address - Phone:972-923-8923
Practice Address - Fax:888-339-3357
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2020-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX565424363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX565424OtherLICENSE