Basic Information
| Provider Information | |||||||||
| NPI: | 1063160562 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BRADEN | ||||||||
| FirstName: | SEIRRA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1100 W REYNOSA AVE | ||||||||
| Address2: | |||||||||
| City: | DE LEON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 764441630 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2548935895 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3804 HIGHWAY 377 S | ||||||||
| Address2: | |||||||||
| City: | BROWNWOOD | ||||||||
| State: | TX | ||||||||
| PostalCode: | 768015120 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3256435167 | ||||||||
| FaxNumber: | 8884984134 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/14/2022 | ||||||||
| LastUpdateDate: | 09/12/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/12/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 4973 | TN | N | Allopathic & Osteopathic Physicians | Pediatrics | 363A00000X | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.