Provider Demographics
NPI:1508843228
Name:BRANDON, CAROLYN S (RN/NP)
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:S
Last Name:BRANDON
Suffix:
Gender:F
Credentials:RN/NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:332 N LAUDERDALE ST
Mailing Address - Street 2:MS 737
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38105-2794
Mailing Address - Country:US
Mailing Address - Phone:901-495-3006
Mailing Address - Fax:901-495-3842
Practice Address - Street 1:332 N LAUDERDALE ST
Practice Address - Street 2:MS 737
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38105-2794
Practice Address - Country:US
Practice Address - Phone:901-495-3006
Practice Address - Fax:901-495-3842
Is Sole Proprietor?:No
Enumeration Date:2005-12-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN29950363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS02228542Medicaid
TN5440728Medicaid