Provider Demographics
NPI:1821303934
Name:FAULKNER, BRANDI SHEA
Entity Type:Individual
Prefix:MRS
First Name:BRANDI
Middle Name:SHEA
Last Name:FAULKNER
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:BRANDI
Other - Middle Name:SHEA
Other - Last Name:TAPP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:175 CAMPBELL LN
Mailing Address - Street 2:
Mailing Address - City:JEFFERSONVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40337-8830
Mailing Address - Country:US
Mailing Address - Phone:859-274-2762
Mailing Address - Fax:
Practice Address - Street 1:175 CAMPBELL LN
Practice Address - Street 2:
Practice Address - City:JEFFERSONVILLE
Practice Address - State:KY
Practice Address - Zip Code:40337-8830
Practice Address - Country:US
Practice Address - Phone:859-274-2762
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-12
Last Update Date:2016-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY222Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist