Provider Demographics
NPI:1740784990
Name:BURKHALTER, BRANDON DEAN
Entity type:Individual
Prefix:
First Name:BRANDON
Middle Name:DEAN
Last Name:BURKHALTER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7905 COUNTY ROAD 3704
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:TX
Mailing Address - Zip Code:75752-5070
Mailing Address - Country:US
Mailing Address - Phone:903-000-0000
Mailing Address - Fax:
Practice Address - Street 1:7903 COUNTY ROAD 3704
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:TX
Practice Address - Zip Code:75752-5070
Practice Address - Country:US
Practice Address - Phone:903-677-8575
Practice Address - Fax:903-677-6838
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-22
Last Update Date:2018-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant