Provider Demographics
NPI:1073091963
Name:ALLEN, BRANDON GARY (FNP-C, PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:BRANDON
Middle Name:GARY
Last Name:ALLEN
Suffix:
Gender:M
Credentials:FNP-C, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2402A LONG CREEK RD
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:MS
Mailing Address - Zip Code:39301-7594
Mailing Address - Country:US
Mailing Address - Phone:601-490-9410
Mailing Address - Fax:
Practice Address - Street 1:2402A LONG CREEK RD
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:MS
Practice Address - Zip Code:39301-7594
Practice Address - Country:US
Practice Address - Phone:601-490-9410
Practice Address - Fax:855-852-1209
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-01
Last Update Date:2024-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS876372163W00000X
MS902766363LF0000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily