Provider Demographics
NPI:1407190705
Name:MADDIGAN, BRANDI NICOLE (ACNP)
Entity Type:Individual
Prefix:
First Name:BRANDI
Middle Name:NICOLE
Last Name:MADDIGAN
Suffix:
Gender:F
Credentials:ACNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3621 22ND ST
Mailing Address - Street 2:SUITE 400
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79410-1301
Mailing Address - Country:US
Mailing Address - Phone:806-791-8484
Mailing Address - Fax:806-794-8498
Practice Address - Street 1:3621 22ND ST
Practice Address - Street 2:SUITE 400
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79410-1301
Practice Address - Country:US
Practice Address - Phone:806-791-8484
Practice Address - Fax:806-791-8499
Is Sole Proprietor?:No
Enumeration Date:2012-11-27
Last Update Date:2021-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX744971363LA2100X
IAL161186363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care