Provider Demographics
NPI:1013561166
Name:BORDELON, BRANDI ELIZABETH (FNP-C)
Entity Type:Individual
Prefix:MISS
First Name:BRANDI
Middle Name:ELIZABETH
Last Name:BORDELON
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 LEE ANN ST
Mailing Address - Street 2:
Mailing Address - City:RAYVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:71269-5529
Mailing Address - Country:US
Mailing Address - Phone:318-403-1590
Mailing Address - Fax:
Practice Address - Street 1:192 BASTILLE LN STE 200
Practice Address - Street 2:
Practice Address - City:RUSTON
Practice Address - State:LA
Practice Address - Zip Code:71270-7150
Practice Address - Country:US
Practice Address - Phone:318-232-1500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-27
Last Update Date:2019-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA206789363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
01071992OtherDOC/ICE