Provider Demographics
NPI:1801017116
Name:STEWART, BRANDY ENOCH (FNP)
Entity Type:Individual
Prefix:
First Name:BRANDY
Middle Name:ENOCH
Last Name:STEWART
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:313 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ASHLAND CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37015-1347
Mailing Address - Country:US
Mailing Address - Phone:615-792-1911
Mailing Address - Fax:615-792-0619
Practice Address - Street 1:313 N MAIN ST
Practice Address - Street 2:
Practice Address - City:ASHLAND CITY
Practice Address - State:TN
Practice Address - Zip Code:37015-1347
Practice Address - Country:US
Practice Address - Phone:615-792-1911
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2022-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN12257363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNP00418599OtherRR MEDICARE
TN3341290Medicaid
TN4164545OtherBCBS OF TN
KY7100018730Medicaid
TN4164551OtherBCBS OF TN
TN4164545OtherBCBS OF TN