Individual
BRANDIE FULBRIGHT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
5322 22ND ST, LUBBOCK, TX 79407-2117
(210) 268-7759
Mailing address
5322 22ND STREET, LUBBOCK, TX 79407
(210) 268-7759
Taxonomy
Speciality
Code
Description
License number
State
315P00000X
Intellectual Disabilities Intermediate Care Facility
Primary
007350
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
007350
—
TX
Enumeration date
08/28/2016
Last updated
09/21/2016
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