Provider Demographics
NPI:1457641276
Name:LOCKLEY, BRANDI RAWLS (FNP, RNFA)
Entity Type:Individual
Prefix:
First Name:BRANDI
Middle Name:RAWLS
Last Name:LOCKLEY
Suffix:
Gender:F
Credentials:FNP, RNFA
Other - Prefix:
Other - First Name:BRANDI
Other - Middle Name:KAY
Other - Last Name:RAWLS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNP
Mailing Address - Street 1:415 S 28TH AVE
Mailing Address - Street 2:
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39401-7246
Mailing Address - Country:US
Mailing Address - Phone:601-579-5459
Mailing Address - Fax:601-579-5240
Practice Address - Street 1:415 S 28TH AVE
Practice Address - Street 2:
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39401-7246
Practice Address - Country:US
Practice Address - Phone:601-579-5459
Practice Address - Fax:601-268-5733
Is Sole Proprietor?:No
Enumeration Date:2011-04-13
Last Update Date:2020-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS871360163WR0006X, 363LF0000X
MSR871360363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First Assistant
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS3310161OtherUNITED HEALTHCARE
MSP00974930OtherRAILROAD MEDICARE
MS06136312Medicaid
MS06136312OtherMAGNOLIA HEALTH PLAN
MS3310161OtherUHC
MS9779665OtherAETNA
MS3310161OtherUNITED HEALTHCARE