Provider Demographics
NPI:1013721109
Name:LASSITER, BRANDY
Entity type:Individual
Prefix:MRS
First Name:BRANDY
Middle Name:
Last Name:LASSITER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:523 6TH AVE
Mailing Address - Street 2:
Mailing Address - City:CHICKASAW
Mailing Address - State:AL
Mailing Address - Zip Code:36611-2338
Mailing Address - Country:US
Mailing Address - Phone:251-259-3894
Mailing Address - Fax:
Practice Address - Street 1:523 6TH AVE
Practice Address - Street 2:
Practice Address - City:CHICKASAW
Practice Address - State:AL
Practice Address - Zip Code:36611-2338
Practice Address - Country:US
Practice Address - Phone:251-259-3894
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-06
Last Update Date:2025-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes253Z00000XAgenciesIn Home Supportive Care
No374U00000XNursing Service Related ProvidersHome Health AideGroup - Multi-Specialty