Leticia Yvonne Brazil, MILITARY PROVIDER

Primary specialty

Independent Duty Medical TechniciansTaxonomy code 1710I1003X

Practice address

331 Sijan Ave.
Whiteman AFB, MO 65305-5001

Phone

(940) 704-8099

NPI assigned

Apr 10, 2012

Last updated

Feb 17, 2022By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other names 1

• Leticia Yvonne Martin Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1334016000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1645056000000",
    "number": "1174889562",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "207 SW T HWY",
            "city": "KINGSVILLE",
            "state": "MO",
            "postal_code": "640619229",
            "telephone_number": "940-704-8099"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "331 SIJAN AVE.",
            "city": "WHITEMAN AFB",
            "state": "MO",
            "postal_code": "653055001",
            "telephone_number": "940-704-8099"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRAZIL",
        "first_name": "LETICIA",
        "middle_name": "YVONNE",
        "credential": "MILITARY PROVIDER",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-04-10",
        "last_updated": "2022-02-17",
        "certification_date": "2022-02-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "146L00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medical Technician, Paramedic",
            "state": "GA",
            "license": "M5025933",
            "primary": false
        },
        {
            "code": "1710I1003X",
            "taxonomy_group": "",
            "desc": "Military Health Care Provider, Independent Duty Medical Technicians",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "LETICIA",
            "last_name": "MARTIN",
            "middle_name": "YVONNE",
            "credential": "PARAMEDIC",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Erik Berger
• Jason Robert Bingham
• Lucas Abinadi Bohannan, D.O.
• Angela Faith Boone, LCSW
• Djoanna Marie Boyd, PA-C
• Whitney Nicole Brooks, LCSW
• Brittney Broshous, LCSW
• Sarah D Burden, OTRL
• Christopher J Button
• Samantha Cecile Campbell, LCSW

• Independent Duty Medical Technicians in Whiteman AFB, MO
• Providers in Whiteman AFB, MO by specialty
• Independent Duty Medical Technicians in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 17, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.