Provider Demographics
NPI:1245331792
Name:CHADWICK, BRANDILYN KAY (RN, FNPC)
Entity type:Individual
Prefix:MRS
First Name:BRANDILYN
Middle Name:KAY
Last Name:CHADWICK
Suffix:
Gender:F
Credentials:RN, FNPC
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Mailing Address - Street 1:1055 CLARKSVILLE STREET
Mailing Address - Street 2:SUITE 185
Mailing Address - City:PARIS
Mailing Address - State:TX
Mailing Address - Zip Code:75460
Mailing Address - Country:US
Mailing Address - Phone:903-905-4945
Mailing Address - Fax:903-905-4949
Practice Address - Street 1:1055 CLARKSVILLE ST STE 130
Practice Address - Street 2:
Practice Address - City:PARIS
Practice Address - State:TX
Practice Address - Zip Code:75460-0208
Practice Address - Country:US
Practice Address - Phone:903-905-4945
Practice Address - Fax:903-905-4949
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2018-02-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX625634363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX179261602Medicaid
TX179261602Medicaid
TX612168Medicare ID - Type UnspecifiedPROVIDER NUMBER