Provider Demographics
NPI:1477658201
Name:HENRY, BRANDIE RINAUDO (PA C)
Entity type:Individual
Prefix:
First Name:BRANDIE
Middle Name:RINAUDO
Last Name:HENRY
Suffix:
Gender:
Credentials:PA C
Other - Prefix:MS
Other - First Name:BRANDIE
Other - Middle Name:MICHELLE
Other - Last Name:RINAUDO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA C
Mailing Address - Street 1:7777 HENNESSY BLVD
Mailing Address - Street 2:SUITE 1008
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70808-4300
Mailing Address - Country:US
Mailing Address - Phone:225-766-0416
Mailing Address - Fax:225-769-9212
Practice Address - Street 1:7777 HENNESSY BLVD
Practice Address - Street 2:SUITE 1008
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70808-4300
Practice Address - Country:US
Practice Address - Phone:225-766-0416
Practice Address - Fax:225-769-9212
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2025-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAA10438363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1625949Medicaid
LA1625949Medicaid
LA56868PB57Medicare PIN