Provider Demographics
NPI:1013226679
Name:ADAMS, BRANDY LETICIA (BACHELORS IECE)
Entity Type:Individual
Prefix:MRS
First Name:BRANDY
Middle Name:LETICIA
Last Name:ADAMS
Suffix:
Gender:F
Credentials:BACHELORS IECE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:349 BRIGHTON AVE
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42101-9087
Mailing Address - Country:US
Mailing Address - Phone:859-319-7616
Mailing Address - Fax:
Practice Address - Street 1:349 BRIGHTON AVE
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42101-9087
Practice Address - Country:US
Practice Address - Phone:859-319-7616
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-30
Last Update Date:2010-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY200700812174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist