Provider Demographics
NPI:1114249976
Name:TINSLEY, BRANDY NICHOLE
Entity Type:Individual
Prefix:MRS
First Name:BRANDY
Middle Name:NICHOLE
Last Name:TINSLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:164 LILY DR
Mailing Address - Street 2:
Mailing Address - City:MAUMELLE
Mailing Address - State:AR
Mailing Address - Zip Code:72113-5828
Mailing Address - Country:US
Mailing Address - Phone:501-202-2685
Mailing Address - Fax:501-202-2003
Practice Address - Street 1:164 LILY DR
Practice Address - Street 2:
Practice Address - City:MAUMELLE
Practice Address - State:AR
Practice Address - Zip Code:72113-5828
Practice Address - Country:US
Practice Address - Phone:501-202-2685
Practice Address - Fax:501-202-2003
Is Sole Proprietor?:No
Enumeration Date:2010-02-22
Last Update Date:2010-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPTA1888225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant