Provider Demographics
NPI:1548733603
Name:MADAKA, BRANDI L (NP)
Entity Type:Individual
Prefix:MRS
First Name:BRANDI
Middle Name:L
Last Name:MADAKA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1312 WHIRLWIND ST
Mailing Address - Street 2:
Mailing Address - City:BRYANT
Mailing Address - State:AR
Mailing Address - Zip Code:72022-6612
Mailing Address - Country:US
Mailing Address - Phone:501-258-8039
Mailing Address - Fax:
Practice Address - Street 1:425 W CAPITOL AVE STE 435
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72201-3642
Practice Address - Country:US
Practice Address - Phone:501-209-8671
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-10
Last Update Date:2022-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA005964363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner