Provider Demographics
NPI:1457930703
Name:TATTERSON, BRANDY DENISE (CPNP-PC)
Entity type:Individual
Prefix:
First Name:BRANDY
Middle Name:DENISE
Last Name:TATTERSON
Suffix:
Gender:F
Credentials:CPNP-PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 EXETER ST
Mailing Address - Street 2:
Mailing Address - City:MANTEO
Mailing Address - State:NC
Mailing Address - Zip Code:27954-9400
Mailing Address - Country:US
Mailing Address - Phone:252-475-5038
Mailing Address - Fax:
Practice Address - Street 1:109 EXETER ST
Practice Address - Street 2:
Practice Address - City:MANTEO
Practice Address - State:NC
Practice Address - Zip Code:27954-9400
Practice Address - Country:US
Practice Address - Phone:252-475-5038
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-05
Last Update Date:2021-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC255031163WC1500X
NC5014941363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No163WC1500XNursing Service ProvidersRegistered NurseCommunity Health