| Provider / Organization | NPI | Date Certified |
|---|---|---|
| BRAEDEN RYAN SPIVEY | 1114659513 | 2022-06-26 |
Braeden Ryan Spivey is registered with the National Plan and Provider Enumeration System and has been issued an National Provider Identifier (NPI) of 1114659513. Registration indicates Braeden Ryan Spivey is a provider of access to adult/geriatric primary care providers services with a specialization in Physician Assistants & Advanced Practice Nursing Providers, Physician Assistant Access to Pediatric Primary Care Providers (Physician Assistants & Advanced Practice Nursing Providers, Physician Assistant) (Physician Assistant, ) (Physician Assistants & Advanced Practice Nursing Providers, Physician Assistant) (All Other Specialties & Provider Types, ) (Physician Assistant, Physician Assistants & Advanced Practice Nursing Providers)
| Entity Type | Individual |
| Provider Name | Braeden Ryan Spivey |
| Practice Office Address | 810 N ZANG BLVD DALLAS, TX US |
| Practice Office Telephone | 9566657049 |
| Mailing Address | 810 N ZANG BLVD DALLAS, TX 752084263 US |
| Business Telephone | 2149414243 |
| Business Fax | 2149411153 |
| Address | City / State | Phone / Fax |
|---|---|---|
| 12230 Coit Rd Ste 130 | Dallas, TX 752512323 | 9725662663 |
| 3450 W Wheatland Rd Ste 340 | Dallas, TX 752374411 | 2149431171 |
| Code | Practice | License No State |
|---|---|---|
| 363A00000X PRIMARY | Access to Adult/Geriatric Primary Care Providers Physician Assistants & Advanced Practice Nursing Providers Physician AssistantAccess to Pediatric Primary Care Providers Physician Assistants & Advanced Practice Nursing Providers Physician Assistant Physician Assistant Physician Assistants & Advanced Practice Nursing Providers Physician Assistant All Other Specialties & Provider Types Physician Assistant Physician Assistants & Advanced Practice Nursing Providers | PA16543
TX |