Provider Demographics
NPI:1972268399
Name:RAGHUNATH, BRIANNA
Entity type:Individual
Prefix:
First Name:BRIANNA
Middle Name:
Last Name:RAGHUNATH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1729 WESTON BRENT LN STE A
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79935-3013
Mailing Address - Country:US
Mailing Address - Phone:915-256-9751
Mailing Address - Fax:915-974-2344
Practice Address - Street 1:9999 KENWORTHY ST STE 1000
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79924-4412
Practice Address - Country:US
Practice Address - Phone:915-298-3434
Practice Address - Fax:915-298-3434
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-01
Last Update Date:2022-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX866130163W00000X
TX1056906363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1056906OtherAPRN-CNP
TX866130OtherRN