Provider Demographics
NPI:1619435567
Name:KYSE, BRANDY MONIQUE
Entity Type:Individual
Prefix:MRS
First Name:BRANDY
Middle Name:MONIQUE
Last Name:KYSE
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:BRANDY
Other - Middle Name:MONIQUE
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:860 E RIVER PL STE 100
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39202-3442
Mailing Address - Country:US
Mailing Address - Phone:228-235-5199
Mailing Address - Fax:
Practice Address - Street 1:3452 PASCAGOULA ST STE 3
Practice Address - Street 2:
Practice Address - City:PASCAGOULA
Practice Address - State:MS
Practice Address - Zip Code:39567-3203
Practice Address - Country:US
Practice Address - Phone:228-712-8024
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-11
Last Update Date:2019-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor