Provider Demographics
NPI:1801256524
Name:SCROGGINS, BRANDI LANEA (NPPC)
Entity type:Individual
Prefix:
First Name:BRANDI
Middle Name:LANEA
Last Name:SCROGGINS
Suffix:
Gender:F
Credentials:NPPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1988
Mailing Address - Street 2:
Mailing Address - City:HAZARD
Mailing Address - State:KY
Mailing Address - Zip Code:41702-1988
Mailing Address - Country:US
Mailing Address - Phone:606-435-7643
Mailing Address - Fax:606-436-5282
Practice Address - Street 1:3400 LAFAYETTE RD STE 200
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46222-1147
Practice Address - Country:US
Practice Address - Phone:317-291-7422
Practice Address - Fax:317-291-7433
Is Sole Proprietor?:No
Enumeration Date:2016-02-24
Last Update Date:2023-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71006100A363L00000X
IN71006100B363L00000X
KY3012719363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner