Provider Demographics
NPI:1588017792
Name:NEFF-SHORT, BRANDI M (APRN)
Entity type:Individual
Prefix:
First Name:BRANDI
Middle Name:M
Last Name:NEFF-SHORT
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:BRANDI
Other - Middle Name:M
Other - Last Name:DENSMORE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:4010 DUPONT CIR STE 403
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40207-4837
Mailing Address - Country:US
Mailing Address - Phone:502-544-7176
Mailing Address - Fax:
Practice Address - Street 1:4010 DUPONT CIR STE 403
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-4837
Practice Address - Country:US
Practice Address - Phone:502-829-7476
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-22
Last Update Date:2023-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71006587A363LF0000X
KY3010522363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
ININ1189178OtherIN MEDICARE
IN201400530Medicaid