Provider Demographics
NPI:1194262279
Name:BROWN, BRANDI LEA (CPNP-AC)
Entity type:Individual
Prefix:MRS
First Name:BRANDI
Middle Name:LEA
Last Name:BROWN
Suffix:
Gender:F
Credentials:CPNP-AC
Other - Prefix:
Other - First Name:BRANDI
Other - Middle Name:LEA
Other - Last Name:CRUMP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CPNP-AC
Mailing Address - Street 1:8003 CASTLEWAY DR
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46250-1946
Mailing Address - Country:US
Mailing Address - Phone:317-576-1335
Mailing Address - Fax:317-343-6562
Practice Address - Street 1:1901 W WESTERN AVE STE B
Practice Address - Street 2:
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46619-3570
Practice Address - Country:US
Practice Address - Phone:574-234-9033
Practice Address - Fax:574-847-7200
Is Sole Proprietor?:No
Enumeration Date:2017-01-26
Last Update Date:2023-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP132688363LP0222X
IN71010016A363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No363LP0222XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics, Critical Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN300039607Medicaid