Provider Demographics
NPI:1558035121
Name:WOMACK, BRANDON DALE (APRN)
Entity Type:Individual
Prefix:
First Name:BRANDON
Middle Name:DALE
Last Name:WOMACK
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 39
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:AR
Mailing Address - Zip Code:72536-0039
Mailing Address - Country:US
Mailing Address - Phone:870-373-2209
Mailing Address - Fax:
Practice Address - Street 1:195 HOSPITAL DR STE A
Practice Address - Street 2:
Practice Address - City:CHEROKEE VILLAGE
Practice Address - State:AR
Practice Address - Zip Code:72529-7330
Practice Address - Country:US
Practice Address - Phone:870-257-6060
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-05
Last Update Date:2024-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR214705363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily