Provider Demographics
NPI:1225207442
Name:ARCHDALE, BRANDY RENEE (RN)
Entity Type:Individual
Prefix:
First Name:BRANDY
Middle Name:RENEE
Last Name:ARCHDALE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:BRANDY
Other - Middle Name:RENEE
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2932 BRIGGS PL
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40511-8874
Mailing Address - Country:US
Mailing Address - Phone:859-536-6051
Mailing Address - Fax:
Practice Address - Street 1:2932 BRIGGS PL
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40511-8874
Practice Address - Country:US
Practice Address - Phone:859-536-6051
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-21
Last Update Date:2008-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1108995163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse