Provider Demographics
NPI:1306883426
Name:DUPRE, BRANDON P (NP)
Entity type:Individual
Prefix:
First Name:BRANDON
Middle Name:P
Last Name:DUPRE
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32939 TAMINA RD STE 104
Mailing Address - Street 2:
Mailing Address - City:MAGNOLIA
Mailing Address - State:TX
Mailing Address - Zip Code:77354-4177
Mailing Address - Country:US
Mailing Address - Phone:281-985-5698
Mailing Address - Fax:
Practice Address - Street 1:32939 TAMINA RD STE 104
Practice Address - Street 2:
Practice Address - City:MAGNOLIA
Practice Address - State:TX
Practice Address - Zip Code:77354-4177
Practice Address - Country:US
Practice Address - Phone:281-985-5698
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-31
Last Update Date:2023-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP04605363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1014311Medicaid
LA1014311Medicaid