Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Tyler Jack Branham, PA-C, ATC

Individual provider Athletic Trainer · NPI 1679143812

Tyler Jack Branham, PA-C, ATC is a Physician Assistant in Lubbock, Texas. Qualified in 2021, 5 years ago. Practices with Dora Roberts Rehabilitation Center, a 112-clinician group and accepts Medicare assignment. Licensed in Texas.

Years since qualifying
5
Licensed in
TX
In the registry since
2021
Specialties on file
2
What do these letters mean?
PA-C — Physician Assistant, Certified
A physician assistant who holds current national certification.
ATC — Certified Athletic Trainer
Prevents and treats sport and activity injuries.

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Practice location Address checks out

4110 22nd Pl
Lubbock, TX 79410-1122
Phone: (806) 792-4329
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X · Licence PA14675 (TX)
Athletic Trainer Taxonomy 2255A2300X · Licence AT6761 (TX)

Record details

NPI number1679143812
Entity typeIndividual (Type 1)
GenderMale
Credentials PA-C , ATC
Sole proprietorNo
NPI enumeratedJune 29, 2021
Last updated in NPPESAugust 11, 2021
Certification dateAugust 11, 2021

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2021 (5 years in practice)
Group practice Dora Roberts Rehabilitation Center — 112 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations2 on file with Medicare

Other providers in Lubbock