Provider Demographics
NPI:1073630307
Name:GARRIS, BRANDI RENEE (ACNP)
Entity Type:Individual
Prefix:
First Name:BRANDI
Middle Name:RENEE
Last Name:GARRIS
Suffix:
Gender:F
Credentials:ACNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 RAWLS SPRINGS LOOP RD
Mailing Address - Street 2:
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39402-7801
Mailing Address - Country:US
Mailing Address - Phone:601-582-9553
Mailing Address - Fax:601-582-9553
Practice Address - Street 1:20 RAWLS SPRINGS LOOP RD
Practice Address - Street 2:
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39402-7801
Practice Address - Country:US
Practice Address - Phone:601-582-9553
Practice Address - Fax:601-582-9553
Is Sole Proprietor?:No
Enumeration Date:2007-03-23
Last Update Date:2014-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR853120363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MSP00417383OtherRAILROAD MEDICARE
MS01755393Medicaid
MS500001239Medicare PIN