Provider Demographics
NPI:1285934646
Name:BURRAGE, BRANDON C (FNP-C)
Entity type:Individual
Prefix:MR
First Name:BRANDON
Middle Name:C
Last Name:BURRAGE
Suffix:
Gender:M
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3150 APPALOOSA CIR
Mailing Address - Street 2:
Mailing Address - City:SAN ANGELO
Mailing Address - State:TX
Mailing Address - Zip Code:76901-5225
Mailing Address - Country:US
Mailing Address - Phone:325-227-8309
Mailing Address - Fax:325-227-8313
Practice Address - Street 1:3150 APPALOOSA CIR
Practice Address - Street 2:
Practice Address - City:SAN ANGELO
Practice Address - State:TX
Practice Address - Zip Code:76901-5225
Practice Address - Country:US
Practice Address - Phone:325-227-8309
Practice Address - Fax:325-227-8313
Is Sole Proprietor?:No
Enumeration Date:2010-11-01
Last Update Date:2010-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX729559363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily