Provider Demographics
NPI:1043541659
Name:MOUNTCASTLE, BRANDY NORRIS (PA-C)
Entity Type:Individual
Prefix:
First Name:BRANDY
Middle Name:NORRIS
Last Name:MOUNTCASTLE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LILLINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27546-7681
Mailing Address - Country:US
Mailing Address - Phone:910-984-1152
Mailing Address - Fax:910-984-1171
Practice Address - Street 1:701 S MAIN ST
Practice Address - Street 2:
Practice Address - City:LILLINGTON
Practice Address - State:NC
Practice Address - Zip Code:27546-7681
Practice Address - Country:US
Practice Address - Phone:910-514-1152
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-01-21
Last Update Date:2021-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-02148363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant