Provider Demographics
NPI:1821541673
Name:PACE, BRANDY (CNP)
Entity Type:Individual
Prefix:
First Name:BRANDY
Middle Name:
Last Name:PACE
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:425 W JACKSON ST
Mailing Address - Street 2:
Mailing Address - City:PIGGOTT
Mailing Address - State:AR
Mailing Address - Zip Code:72454-1538
Mailing Address - Country:US
Mailing Address - Phone:870-598-2236
Mailing Address - Fax:870-598-3080
Practice Address - Street 1:425 W JACKSON ST
Practice Address - Street 2:
Practice Address - City:PIGGOTT
Practice Address - State:AR
Practice Address - Zip Code:72454-1538
Practice Address - Country:US
Practice Address - Phone:870-598-2236
Practice Address - Fax:870-598-3080
Is Sole Proprietor?:No
Enumeration Date:2016-07-28
Last Update Date:2016-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA004851363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily