Provider Demographics
NPI:1679855308
Name:MALONE, BRANDI C (FNP-C)
Entity Type:Individual
Prefix:
First Name:BRANDI
Middle Name:C
Last Name:MALONE
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17604 E LAKE ESTATES DR
Mailing Address - Street 2:
Mailing Address - City:ARP
Mailing Address - State:TX
Mailing Address - Zip Code:75750-9688
Mailing Address - Country:US
Mailing Address - Phone:903-920-9831
Mailing Address - Fax:903-747-3013
Practice Address - Street 1:4293 KINSEY DR
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75703-1004
Practice Address - Country:US
Practice Address - Phone:903-592-5670
Practice Address - Fax:888-960-2797
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-20
Last Update Date:2021-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF0811448363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX2930422Medicaid
738639OtherTEXAS BOARD OF NURSING NP LICENSE
TXF0811448OtherAANP
TXAP120947OtherFNP LICENSE
738639OtherTEXAS BOARD OF NURSING NP LICENSE