Provider Demographics
NPI:1124764279
Name:BRANDON, BRENDA LEE (FNP-BC)
Entity type:Individual
Prefix:
First Name:BRENDA
Middle Name:LEE
Last Name:BRANDON
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 SPRINGER AVE
Mailing Address - Street 2:
Mailing Address - City:NETTLETON
Mailing Address - State:MS
Mailing Address - Zip Code:38858-6098
Mailing Address - Country:US
Mailing Address - Phone:662-305-5592
Mailing Address - Fax:
Practice Address - Street 1:2464 MAIN ST
Practice Address - Street 2:
Practice Address - City:PLANTERSVILLE
Practice Address - State:MS
Practice Address - Zip Code:38862-5002
Practice Address - Country:US
Practice Address - Phone:662-842-4877
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-11
Last Update Date:2025-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS905233363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily