Provider Demographics
NPI:1902382799
Name:ANDERSON, BRANDY N (APRN)
Entity Type:Individual
Prefix:
First Name:BRANDY
Middle Name:N
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HARDY
Mailing Address - State:AR
Mailing Address - Zip Code:72542-9566
Mailing Address - Country:US
Mailing Address - Phone:870-856-2100
Mailing Address - Fax:870-994-7488
Practice Address - Street 1:101 W MAIN ST
Practice Address - Street 2:
Practice Address - City:HARDY
Practice Address - State:AR
Practice Address - Zip Code:72542-9566
Practice Address - Country:US
Practice Address - Phone:870-856-2100
Practice Address - Fax:870-994-7488
Is Sole Proprietor?:No
Enumeration Date:2018-07-14
Last Update Date:2018-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA005780363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily