Provider Demographics
NPI:1356732820
Name:BRADEN, REBECCA SUE (PA-C)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:SUE
Last Name:BRADEN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:BECKY
Other - Middle Name:
Other - Last Name:BRADEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:4333 N JOSEY LN
Mailing Address - Street 2:PLAZA II, SUITE 302
Mailing Address - City:CARROLLTON
Mailing Address - State:TX
Mailing Address - Zip Code:75010-4629
Mailing Address - Country:US
Mailing Address - Phone:972-394-8844
Mailing Address - Fax:972-492-9248
Practice Address - Street 1:4333 N JOSEY LN
Practice Address - Street 2:PLAZA II, SUITE 302
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75010-4629
Practice Address - Country:US
Practice Address - Phone:972-394-8844
Practice Address - Fax:972-492-9248
Is Sole Proprietor?:No
Enumeration Date:2015-02-05
Last Update Date:2024-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA09639363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant