Provider Demographics
NPI:1619004264
Name:DAVIS, BRANDI GRAY (NP)
Entity Type:Individual
Prefix:
First Name:BRANDI
Middle Name:GRAY
Last Name:DAVIS
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 1:1438 OXBOW DR
Mailing Address - Street 2:
Mailing Address - City:CEDAR HILL
Mailing Address - State:TX
Mailing Address - Zip Code:75104-4006
Mailing Address - Country:US
Mailing Address - Phone:504-251-0493
Mailing Address - Fax:
Practice Address - Street 1:5640 READ BLVD STE 220
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70127-7805
Practice Address - Country:US
Practice Address - Phone:504-244-0455
Practice Address - Fax:504-244-0433
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-28
Last Update Date:2021-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP05059363LF0000X, 163WP2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WP2201XNursing Service ProvidersRegistered NurseAmbulatory Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
LAAP05059OtherLOUISIANA
TXAP115539OtherTX LISCENSURE