Provider Demographics
NPI:1710578315
Name:ZOLLARS, BRANDY (PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:BRANDY
Middle Name:
Last Name:ZOLLARS
Suffix:
Gender:F
Credentials:PMHNP-BC
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 401
Mailing Address - Street 2:
Mailing Address - City:HOMER
Mailing Address - State:AK
Mailing Address - Zip Code:99603-0401
Mailing Address - Country:US
Mailing Address - Phone:907-299-6410
Mailing Address - Fax:262-646-3158
Practice Address - Street 1:158 W PIONEER AVE STE C
Practice Address - Street 2:
Practice Address - City:HOMER
Practice Address - State:AK
Practice Address - Zip Code:99603-7500
Practice Address - Country:US
Practice Address - Phone:907-299-6410
Practice Address - Fax:833-411-1331
Is Sole Proprietor?:No
Enumeration Date:2021-01-27
Last Update Date:2023-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTAPRN-191599363LP0808X
AZ270929363LP0808X
COAPN.0998847-NP363LP0808X
WAAP61245432363LP0808X
WI10789-33363LP0808X
AK203115363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health