Provider Demographics
NPI:1134556616
Name:CARSON, BRANDY NICOLE (NP)
Entity type:Individual
Prefix:MS
First Name:BRANDY
Middle Name:NICOLE
Last Name:CARSON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:307 REED ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:TN
Mailing Address - Zip Code:37148-1708
Mailing Address - Country:US
Mailing Address - Phone:615-525-8792
Mailing Address - Fax:
Practice Address - Street 1:307 REED ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:TN
Practice Address - Zip Code:37148-1708
Practice Address - Country:US
Practice Address - Phone:615-525-8792
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-30
Last Update Date:2023-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN0000017928363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner