Provider Demographics
NPI:1083867089
Name:MCCLAUGHRY, BRANDY JO (RN, ANP)
Entity Type:Individual
Prefix:
First Name:BRANDY
Middle Name:JO
Last Name:MCCLAUGHRY
Suffix:
Gender:F
Credentials:RN, ANP
Other - Prefix:
Other - First Name:BRANDY
Other - Middle Name:JO
Other - Last Name:RENZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN, ANP
Mailing Address - Street 1:250 N SHADELAND AVE
Mailing Address - Street 2:STE 130 PROVIDER ENROLLMENT
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46219-4959
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2401 W UNIVERSITY AVE
Practice Address - Street 2:
Practice Address - City:MUNCIE
Practice Address - State:IN
Practice Address - Zip Code:47303
Practice Address - Country:US
Practice Address - Phone:260-969-1950
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-11-04
Last Update Date:2020-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71002848A363L00000X, 363LA2200X
IN28157189A163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000626639OtherANTHEM BC/BS
INP00719994OtherRAILROAD MEDICARE
IN200935360Medicaid
IN000000609123OtherANTHEM BC/BS
IN000000659985OtherANTHEM BC/BS
INP00742234OtherRAILROAD MEDICARE
INP01087886Medicare PIN
IN200935360Medicaid
INP00742234OtherRAILROAD MEDICARE
INP00719994OtherRAILROAD MEDICARE
IN000000659985OtherANTHEM BC/BS