Provider Demographics
NPI:1578010716
Name:HARDEN, BRANDI GYNN (APRN-CNP)
Entity Type:Individual
Prefix:MS
First Name:BRANDI
Middle Name:GYNN
Last Name:HARDEN
Suffix:
Gender:F
Credentials:APRN-CNP
Other - Prefix:
Other - First Name:BRANDI
Other - Middle Name:GYNN
Other - Last Name:BOLIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:4785 COUNTY ROAD 1520
Mailing Address - Street 2:
Mailing Address - City:ADA
Mailing Address - State:OK
Mailing Address - Zip Code:74820
Mailing Address - Country:US
Mailing Address - Phone:580-421-7281
Mailing Address - Fax:
Practice Address - Street 1:36640 HWY 270 & BARKING WATER RD
Practice Address - Street 2:
Practice Address - City:WEWOKA
Practice Address - State:OK
Practice Address - Zip Code:74884
Practice Address - Country:US
Practice Address - Phone:405-257-6282
Practice Address - Fax:405-257-3344
Is Sole Proprietor?:No
Enumeration Date:2016-09-06
Last Update Date:2023-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK91059163W00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK1578010716Medicaid