Provider Demographics
NPI:1861455834
Name:WORLEY, BRANDY LYNN (FNP)
Entity Type:Individual
Prefix:MRS
First Name:BRANDY
Middle Name:LYNN
Last Name:WORLEY
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 1:1 VETERANS WAY
Mailing Address - Street 2:
Mailing Address - City:MEXICO
Mailing Address - State:MO
Mailing Address - Zip Code:65265-3379
Mailing Address - Country:US
Mailing Address - Phone:573-581-9630
Mailing Address - Fax:573-581-0315
Practice Address - Street 1:1 VETERANS WAY
Practice Address - Street 2:
Practice Address - City:MEXICO
Practice Address - State:MO
Practice Address - Zip Code:65265-3379
Practice Address - Country:US
Practice Address - Phone:573-581-9630
Practice Address - Fax:573-581-0315
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2000149196363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOQ22746Medicare UPIN