Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | AP136927 | TX |
NPI | 1033612585 |
---|---|
Provider Name | Brooke Nicole Raney |
First Address | Texarkana, TX 75503-0711 |
Second Address | Texarkana, TX 75503 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/03/2018 |
Last Update Date | 14/06/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
AP136927 | TEXAS BOARD OF NURSING (01) | TX |