Provider Demographics
NPI:1336573492
Name:PAYNE, BRANDI BOUDREAUX (FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:BRANDI
Middle Name:BOUDREAUX
Last Name:PAYNE
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2122 SOUTH RICHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:GONZALES
Mailing Address - State:LA
Mailing Address - Zip Code:70737-4057
Mailing Address - Country:US
Mailing Address - Phone:225-324-1645
Mailing Address - Fax:
Practice Address - Street 1:827 N PINE ST
Practice Address - Street 2:
Practice Address - City:GRAMERCY
Practice Address - State:LA
Practice Address - Zip Code:70052-3602
Practice Address - Country:US
Practice Address - Phone:225-869-9200
Practice Address - Fax:225-869-9241
Is Sole Proprietor?:No
Enumeration Date:2013-08-26
Last Update Date:2022-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP07475363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2346806Medicaid