Provider Demographics
NPI:1740077155
Name:WYRICK, BRANDON DEMOND
Entity type:Individual
Prefix:
First Name:BRANDON
Middle Name:DEMOND
Last Name:WYRICK
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 6435
Mailing Address - Street 2:
Mailing Address - City:TEXARKANA
Mailing Address - State:TX
Mailing Address - Zip Code:75505-6435
Mailing Address - Country:US
Mailing Address - Phone:903-314-8459
Mailing Address - Fax:
Practice Address - Street 1:3 MORROW DR
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:TX
Practice Address - Zip Code:76021-5675
Practice Address - Country:US
Practice Address - Phone:903-314-8459
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-21
Last Update Date:2025-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No373H00000XNursing Service Related ProvidersDay Training/Habilitation Specialist
No174H00000XOther Service ProvidersHealth Educator
No251E00000XAgenciesHome Health
No251J00000XAgenciesNursing Care
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
No372600000XNursing Service Related ProvidersAdult Companion
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No374U00000XNursing Service Related ProvidersHome Health Aide