Provider Demographics
NPI:1770191835
Name:SAMPSON, BRANDY (FNP)
Entity Type:Individual
Prefix:
First Name:BRANDY
Middle Name:
Last Name:SAMPSON
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:MRS
Other - First Name:BRANDY
Other - Middle Name:JO
Other - Last Name:SAMPSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:FNP
Mailing Address - Street 1:7 PROFESSIONAL DR
Mailing Address - Street 2:
Mailing Address - City:SNOW HILL
Mailing Address - State:NC
Mailing Address - Zip Code:28580-1332
Mailing Address - Country:US
Mailing Address - Phone:125-274-7816
Mailing Address - Fax:
Practice Address - Street 1:205 MARTIN LUTHER KING JR PKWY
Practice Address - Street 2:
Practice Address - City:SNOW HILL
Practice Address - State:NC
Practice Address - Zip Code:28580
Practice Address - Country:US
Practice Address - Phone:252-747-4199
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-15
Last Update Date:2020-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC261209363L00000X
NC5013563363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner