Provider Demographics
NPI:1962158246
Name:STUBBS, BRANDON KATRELL
Entity type:Individual
Prefix:
First Name:BRANDON
Middle Name:KATRELL
Last Name:STUBBS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2166 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:EUDORA
Mailing Address - State:AR
Mailing Address - Zip Code:71640-2269
Mailing Address - Country:US
Mailing Address - Phone:870-997-1646
Mailing Address - Fax:
Practice Address - Street 1:2166 N MAIN ST
Practice Address - Street 2:
Practice Address - City:EUDORA
Practice Address - State:AR
Practice Address - Zip Code:71640-2269
Practice Address - Country:US
Practice Address - Phone:870-997-1646
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-25
Last Update Date:2022-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider