Provider Demographics
NPI:1841722154
Name:BRANDON, KATIE WHEELER (NP)
Entity type:Individual
Prefix:MRS
First Name:KATIE
Middle Name:WHEELER
Last Name:BRANDON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MS
Other - First Name:KATIE
Other - Middle Name:ROUQUETTE
Other - Last Name:WHEELER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:3602 MATLOCK RD
Mailing Address - Street 2:SUITE 210
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76015-3616
Mailing Address - Country:US
Mailing Address - Phone:817-472-9369
Mailing Address - Fax:
Practice Address - Street 1:3602 MATLOCK RD
Practice Address - Street 2:SUITE 210
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76015
Practice Address - Country:US
Practice Address - Phone:817-472-9369
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-28
Last Update Date:2018-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP133345363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily