Provider Demographics
NPI:1568976413
Name:SMITH, BRANDIE A (FNP)
Entity Type:Individual
Prefix:
First Name:BRANDIE
Middle Name:A
Last Name:SMITH
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:241 THORNWOOD DR
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:LA
Mailing Address - Zip Code:70435-0285
Mailing Address - Country:US
Mailing Address - Phone:504-234-0627
Mailing Address - Fax:
Practice Address - Street 1:19115 FLORIDA AVE.
Practice Address - Street 2:SUITE A
Practice Address - City:ALBANY
Practice Address - State:LA
Practice Address - Zip Code:70711
Practice Address - Country:US
Practice Address - Phone:225-567-7150
Practice Address - Fax:225-567-7120
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-29
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA452815734208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA208D00000XOtherALL CLAIMS