Provider Demographics
NPI:1417385188
Name:BRASS, VANESSA (FNP)
Entity Type:Individual
Prefix:
First Name:VANESSA
Middle Name:
Last Name:BRASS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1025 MARION HWY
Mailing Address - Street 2:
Mailing Address - City:FARMERVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:71241-9314
Mailing Address - Country:US
Mailing Address - Phone:318-368-9745
Mailing Address - Fax:318-368-0072
Practice Address - Street 1:1025 MARION HWY
Practice Address - Street 2:
Practice Address - City:FARMERVILLE
Practice Address - State:LA
Practice Address - Zip Code:71241-9314
Practice Address - Country:US
Practice Address - Phone:318-368-9745
Practice Address - Fax:318-368-0072
Is Sole Proprietor?:No
Enumeration Date:2013-10-16
Last Update Date:2019-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA003989363LF0000X
LAAP07526363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily