Provider Demographics
NPI:1336508720
Name:SMITH, BRANDY (APRN-CNP)
Entity Type:Individual
Prefix:
First Name:BRANDY
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:APRN-CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45 GREENFIELD DR
Mailing Address - Street 2:
Mailing Address - City:MILFORD CENTER
Mailing Address - State:OH
Mailing Address - Zip Code:43045-9006
Mailing Address - Country:US
Mailing Address - Phone:937-408-1912
Mailing Address - Fax:
Practice Address - Street 1:7625 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:OH
Practice Address - Zip Code:43016-9649
Practice Address - Country:US
Practice Address - Phone:146-981-5406
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-15
Last Update Date:2020-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.399138163WP0807X
OHAPRN.CNP.0026871363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0807XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Child & Adolescent