Provider Demographics
NPI:1376349936
Name:FUNCTIONAL HEALING, PLLC
Entity type:Organization
Organization Name:FUNCTIONAL HEALING, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:BRANDY
Authorized Official - Middle Name:DANIELLE
Authorized Official - Last Name:VANDERGRIFFT
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:979-614-0115
Mailing Address - Street 1:207 THAT WAY ST STE C
Mailing Address - Street 2:
Mailing Address - City:LAKE JACKSON
Mailing Address - State:TX
Mailing Address - Zip Code:77566-5211
Mailing Address - Country:US
Mailing Address - Phone:979-614-0115
Mailing Address - Fax:979-614-0116
Practice Address - Street 1:207 THAT WAY ST STE C
Practice Address - Street 2:
Practice Address - City:LAKE JACKSON
Practice Address - State:TX
Practice Address - Zip Code:77566-5211
Practice Address - Country:US
Practice Address - Phone:979-614-0115
Practice Address - Fax:979-614-0116
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-24
Last Update Date:2025-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care