Provider Demographics
NPI:1831430560
Name:HENRY, BRANDI R (FNP)
Entity type:Individual
Prefix:
First Name:BRANDI
Middle Name:R
Last Name:HENRY
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6263 POPLAR AVE STE 1032
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38119-4743
Mailing Address - Country:US
Mailing Address - Phone:731-400-0411
Mailing Address - Fax:901-779-6968
Practice Address - Street 1:160 W UNIVERSITY PKWY STE C
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38305-1667
Practice Address - Country:US
Practice Address - Phone:731-660-5116
Practice Address - Fax:731-660-5119
Is Sole Proprietor?:No
Enumeration Date:2013-03-05
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000017372363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily