Provider Demographics
NPI:1235700204
Name:BRANDT, MIRANDA RENEE (APRN FNP-C)
Entity Type:Individual
Prefix:
First Name:MIRANDA
Middle Name:RENEE
Last Name:BRANDT
Suffix:
Gender:F
Credentials:APRN FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5100 W 110TH ST STE 110
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66211-1215
Mailing Address - Country:US
Mailing Address - Phone:913-345-6960
Mailing Address - Fax:
Practice Address - Street 1:5100 W 110TH ST STE 110
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66211-1215
Practice Address - Country:US
Practice Address - Phone:913-345-6960
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-09
Last Update Date:2021-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS53-80335-042363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner