| Doctor Name: | MR. BRETT WAYNE THETFORD |
| NPI Number: | 1861841512 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | FNP-C |
| License Number: | AP129476 |
| Business Practice Address: | 13965 S Fm 4 Santo, TX - 764723436 |
| Business Phone Number: | 9407692303 |
| Business Fax Number: | 9407692306 |
| Mailing Address: | Po Box 65, SANTO |
| State: | TX |
| Postal Code: | 764720065 |
| Phone Number: | 9407692303 |
| Fax Number: | 9407692306 |
| NPI Enumeration Date: | 06/03/2016 |
| NPI Last Update Date: | 06/03/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | AP129476 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | TX |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |