Provider Demographics
NPI:1124257902
Name:SMITH, BRANDY G (FNP-BC)
Entity type:Individual
Prefix:MRS
First Name:BRANDY
Middle Name:G
Last Name:SMITH
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27627 HIGHWAY 442
Mailing Address - Street 2:
Mailing Address - City:SCHLATER
Mailing Address - State:MS
Mailing Address - Zip Code:38952-3221
Mailing Address - Country:US
Mailing Address - Phone:662-299-5208
Mailing Address - Fax:
Practice Address - Street 1:2901 HIGHWAY 82 E
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:MS
Practice Address - Zip Code:38930-2960
Practice Address - Country:US
Practice Address - Phone:662-374-2185
Practice Address - Fax:662-374-2195
Is Sole Proprietor?:No
Enumeration Date:2009-07-14
Last Update Date:2010-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR859059363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily