Provider Demographics
NPI:1902038961
Name:ANDERSON, BRANDI DAWN (APN)
Entity Type:Individual
Prefix:MRS
First Name:BRANDI
Middle Name:DAWN
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:310 BUTTERCUP DR
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN HOME
Mailing Address - State:AR
Mailing Address - Zip Code:72653-2921
Mailing Address - Country:US
Mailing Address - Phone:870-508-7080
Mailing Address - Fax:
Practice Address - Street 1:310 BUTTERCUP DR
Practice Address - Street 2:
Practice Address - City:MOUNTAIN HOME
Practice Address - State:AR
Practice Address - Zip Code:72653-2921
Practice Address - Country:US
Practice Address - Phone:870-508-7080
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-10
Last Update Date:2021-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2011001819363LF0000X
ARA03275 ANP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR179911758Medicaid