Provider Demographics
NPI:1568948909
Name:KANJ, BRANDI NICOLE (NP)
Entity Type:Individual
Prefix:
First Name:BRANDI
Middle Name:NICOLE
Last Name:KANJ
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 1:26866 TREASURES RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:KINGWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:77339-6500
Mailing Address - Country:US
Mailing Address - Phone:913-206-0796
Mailing Address - Fax:
Practice Address - Street 1:26866 TREASURES RIDGE DR
Practice Address - Street 2:
Practice Address - City:KINGWOOD
Practice Address - State:TX
Practice Address - Zip Code:77339-6500
Practice Address - Country:US
Practice Address - Phone:913-206-0796
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-18
Last Update Date:2020-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS78016363LG0600X
TXAP145167363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology