Provider Demographics
NPI:1134351299
Name:CRUMP, BRANDY RENAE (APN)
Entity type:Individual
Prefix:MRS
First Name:BRANDY
Middle Name:RENAE
Last Name:CRUMP
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 1:1111 WINDOVER RD
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72401-6159
Mailing Address - Country:US
Mailing Address - Phone:870-935-5432
Mailing Address - Fax:870-935-4887
Practice Address - Street 1:1111 WINDOVER RD
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72401-6159
Practice Address - Country:US
Practice Address - Phone:870-935-5432
Practice Address - Fax:870-935-4887
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-21
Last Update Date:2009-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA03284363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily