Provider Demographics
NPI:1619681285
Name:PETERS, BRANDI ELANA (APRN)
Entity Type:Individual
Prefix:
First Name:BRANDI
Middle Name:ELANA
Last Name:PETERS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2301 W PLEASANT GROVE RD STE 101
Mailing Address - Street 2:
Mailing Address - City:ROGERS
Mailing Address - State:AR
Mailing Address - Zip Code:72758-7034
Mailing Address - Country:US
Mailing Address - Phone:479-326-8525
Mailing Address - Fax:
Practice Address - Street 1:2301 W PLEASANT GROVE RD STE 101
Practice Address - Street 2:
Practice Address - City:ROGERS
Practice Address - State:AR
Practice Address - Zip Code:72758-7034
Practice Address - Country:US
Practice Address - Phone:479-326-8525
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-09
Last Update Date:2023-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR222368207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine