Provider Demographics
NPI:1508350638
Name:BRANDIEKAY LLC
Entity Type:Organization
Organization Name:BRANDIEKAY LLC
Other - Org Name:CAPE MEDICAL WEIGHT LOSS AND FAMILY PRACTICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OPERATIONS MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:DEBBIE
Authorized Official - Middle Name:
Authorized Official - Last Name:EVANS
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:573-803-0919
Mailing Address - Street 1:2131 WILLIAM ST
Mailing Address - Street 2:
Mailing Address - City:CAPE GIRARDEAU
Mailing Address - State:MO
Mailing Address - Zip Code:63703-5817
Mailing Address - Country:US
Mailing Address - Phone:573-803-0919
Mailing Address - Fax:573-803-0879
Practice Address - Street 1:2131 WILLIAM ST
Practice Address - Street 2:
Practice Address - City:CAPE GIRARDEAU
Practice Address - State:MO
Practice Address - Zip Code:63703-5817
Practice Address - Country:US
Practice Address - Phone:573-803-0919
Practice Address - Fax:573-803-0879
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-21
Last Update Date:2018-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty