Provider Demographics
NPI:1700434958
Name:RIDDICK, BRANDI LEIGH (CRNP)
Entity Type:Individual
Prefix:
First Name:BRANDI
Middle Name:LEIGH
Last Name:RIDDICK
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1105 OAK ST
Mailing Address - Street 2:
Mailing Address - City:COPLAY
Mailing Address - State:PA
Mailing Address - Zip Code:18037-1703
Mailing Address - Country:US
Mailing Address - Phone:484-661-3166
Mailing Address - Fax:
Practice Address - Street 1:1251 S CEDAR CREST BLVD STE 102A
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18103-6205
Practice Address - Country:US
Practice Address - Phone:610-402-3940
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-30
Last Update Date:2019-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP019388207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine