Provider Demographics
NPI:1073292173
Name:WHALEY, BRANDI MIKAL (CLS, CPT)
Entity Type:Individual
Prefix:
First Name:BRANDI
Middle Name:MIKAL
Last Name:WHALEY
Suffix:
Gender:F
Credentials:CLS, CPT
Other - Prefix:
Other - First Name:BRANDI
Other - Middle Name:
Other - Last Name:WHALEY-WHITE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CLS, CPT
Mailing Address - Street 1:9021 MORAY DR
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71129-5127
Mailing Address - Country:US
Mailing Address - Phone:318-518-3901
Mailing Address - Fax:
Practice Address - Street 1:333 TEXAS ST STE 1300
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71101-3783
Practice Address - Country:US
Practice Address - Phone:318-518-3901
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-17
Last Update Date:2024-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
246RP1900X
LA334543246RP1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy