Provider Demographics
NPI:1285913129
Name:SMALLEY, BRANDIE MARIE (PMHNP-BC, PHD)
Entity type:Individual
Prefix:MRS
First Name:BRANDIE
Middle Name:MARIE
Last Name:SMALLEY
Suffix:
Gender:F
Credentials:PMHNP-BC, PHD
Other - Prefix:
Other - First Name:BRANDIE
Other - Middle Name:MARIE
Other - Last Name:STILES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:309 N QUAIL POINT DR
Mailing Address - Street 2:
Mailing Address - City:O FALLON
Mailing Address - State:MO
Mailing Address - Zip Code:63366-5244
Mailing Address - Country:US
Mailing Address - Phone:314-791-7346
Mailing Address - Fax:314-843-4856
Practice Address - Street 1:309 N QUAIL POINT DR
Practice Address - Street 2:
Practice Address - City:O FALLON
Practice Address - State:MO
Practice Address - Zip Code:63366-5244
Practice Address - Country:US
Practice Address - Phone:314-791-7346
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-10
Last Update Date:2023-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2007005639163W00000X, 363LP0808X
IL041339458163W00000X
IL309.017069363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse