Provider Demographics
NPI:1093293318
Name:SMITH, BRANDI LEE (FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:BRANDI
Middle Name:LEE
Last Name:SMITH
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:BRANDI
Other - Middle Name:FICKLIN
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1305 S 14TH ST
Mailing Address - Street 2:
Mailing Address - City:KINGSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78363-6356
Mailing Address - Country:US
Mailing Address - Phone:361-595-1986
Mailing Address - Fax:361-595-1478
Practice Address - Street 1:1305 S 14TH ST
Practice Address - Street 2:
Practice Address - City:KINGSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78363-6356
Practice Address - Country:US
Practice Address - Phone:361-595-1986
Practice Address - Fax:361-595-1478
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-30
Last Update Date:2018-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP138260363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily