Provider Demographics
NPI:1639458326
Name:WHITE, BRANDI ALISON (APRN)
Entity Type:Individual
Prefix:
First Name:BRANDI
Middle Name:ALISON
Last Name:WHITE
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:PO BOX 3560
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42102-3560
Mailing Address - Country:US
Mailing Address - Phone:270-434-4857
Mailing Address - Fax:270-434-4957
Practice Address - Street 1:47 AKERSVILLE ROAD
Practice Address - Street 2:
Practice Address - City:FOUNTAIN RUN
Practice Address - State:KY
Practice Address - Zip Code:42133-7910
Practice Address - Country:US
Practice Address - Phone:270-434-4857
Practice Address - Fax:270-434-4957
Is Sole Proprietor?:No
Enumeration Date:2011-08-11
Last Update Date:2023-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3007031363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000726435OtherANTHEM
KY7100175560Medicaid
KY7100175560Medicaid