Provider Demographics
NPI:1609509967
Name:MANGHAM, BRITTANY LIU (FNP)
Entity type:Individual
Prefix:
First Name:BRITTANY
Middle Name:LIU
Last Name:MANGHAM
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 KLEINGRASS CT
Mailing Address - Street 2:
Mailing Address - City:BERTRAM
Mailing Address - State:TX
Mailing Address - Zip Code:78605-2201
Mailing Address - Country:US
Mailing Address - Phone:903-746-8767
Mailing Address - Fax:
Practice Address - Street 1:103 THOUSAND OAKS BLVD
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:TX
Practice Address - Zip Code:78628-8757
Practice Address - Country:US
Practice Address - Phone:512-733-5800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-05
Last Update Date:2025-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1059609363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1059609OtherB A MEDICAL AESTHETICS