Provider Demographics
NPI:1891155768
Name:RAICH, BRANDY L (ANP)
Entity Type:Individual
Prefix:
First Name:BRANDY
Middle Name:L
Last Name:RAICH
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:BRANDY
Other - Middle Name:
Other - Last Name:MCKINNIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3023 N BALLAS RD STE 200D
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63131-2328
Mailing Address - Country:US
Mailing Address - Phone:314-996-7272
Mailing Address - Fax:314-996-6785
Practice Address - Street 1:3023 N BALLAS RD
Practice Address - Street 2:STE 200D
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63131-2330
Practice Address - Country:US
Practice Address - Phone:314-996-7888
Practice Address - Fax:314-996-7885
Is Sole Proprietor?:No
Enumeration Date:2016-03-04
Last Update Date:2021-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2016003655363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health