Provider Demographics
NPI:1235255027
Name:PULLIAM, BRANDY R (MHPP)
Entity Type:Individual
Prefix:
First Name:BRANDY
Middle Name:R
Last Name:PULLIAM
Suffix:
Gender:F
Credentials:MHPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HORATIO
Mailing Address - State:AR
Mailing Address - Zip Code:71842-8729
Mailing Address - Country:US
Mailing Address - Phone:870-832-2891
Mailing Address - Fax:870-832-3222
Practice Address - Street 1:601 MAIN ST
Practice Address - Street 2:
Practice Address - City:HORATIO
Practice Address - State:AR
Practice Address - Zip Code:71842-8729
Practice Address - Country:US
Practice Address - Phone:870-832-2891
Practice Address - Fax:870-832-3222
Is Sole Proprietor?:No
Enumeration Date:2007-03-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator