Provider Demographics
NPI:1255196739
Name:GRACE, BRANDY (DNP, RN)
Entity type:Individual
Prefix:
First Name:BRANDY
Middle Name:
Last Name:GRACE
Suffix:
Gender:F
Credentials:DNP, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 OLD WINSTON RD STE 204B
Mailing Address - Street 2:
Mailing Address - City:KERNERSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27284-9965
Mailing Address - Country:US
Mailing Address - Phone:336-992-4242
Mailing Address - Fax:
Practice Address - Street 1:900 OLD WINSTON RD STE 204B
Practice Address - Street 2:
Practice Address - City:KERNERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:27284-9965
Practice Address - Country:US
Practice Address - Phone:336-992-4242
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-14
Last Update Date:2024-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC311077363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care