Provider Demographics
NPI:1346545035
Name:DECOURCEY, BRANDY RENEE
Entity Type:Individual
Prefix:
First Name:BRANDY
Middle Name:RENEE
Last Name:DECOURCEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:BRANDY
Other - Middle Name:RENEE
Other - Last Name:BRADLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PTA
Mailing Address - Street 1:8404 PONDEROSA RDG
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:KY
Mailing Address - Zip Code:41102-9034
Mailing Address - Country:US
Mailing Address - Phone:606-369-6334
Mailing Address - Fax:
Practice Address - Street 1:7625 PARAGON RD STE C
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45459-4063
Practice Address - Country:US
Practice Address - Phone:877-480-6398
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-11
Last Update Date:2011-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYA02110376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide