Provider Demographics
NPI:1003534884
Name:DR BRANDY M BAILLARGEON NURSE PRACTITIONER PSYCHIATRY PLLC
Entity Type:Organization
Organization Name:DR BRANDY M BAILLARGEON NURSE PRACTITIONER PSYCHIATRY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER CEO
Authorized Official - Prefix:
Authorized Official - First Name:BRANDY
Authorized Official - Middle Name:M
Authorized Official - Last Name:BAILLARGEON
Authorized Official - Suffix:
Authorized Official - Credentials:DR
Authorized Official - Phone:907-204-0894
Mailing Address - Street 1:966 STATE HIGHWAY 37
Mailing Address - Street 2:
Mailing Address - City:HAMMOND
Mailing Address - State:NY
Mailing Address - Zip Code:13646-3280
Mailing Address - Country:US
Mailing Address - Phone:907-204-0894
Mailing Address - Fax:
Practice Address - Street 1:966 STATE HIGHWAY 37
Practice Address - Street 2:
Practice Address - City:HAMMOND
Practice Address - State:NY
Practice Address - Zip Code:13646-3280
Practice Address - Country:US
Practice Address - Phone:907-204-0894
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-18
Last Update Date:2022-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY04531031Medicaid