Provider Demographics
NPI:1316104953
Name:FLEISCHMANN, BRANDI MARIE (PA-C)
Entity type:Individual
Prefix:MRS
First Name:BRANDI
Middle Name:MARIE
Last Name:FLEISCHMANN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 FINANCIAL PL
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ELIZABETHTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:42701-4470
Mailing Address - Country:US
Mailing Address - Phone:270-769-0110
Mailing Address - Fax:270-765-6953
Practice Address - Street 1:103 FINANCIAL PL
Practice Address - Street 2:SUITE 100
Practice Address - City:ELIZABETHTOWN
Practice Address - State:KY
Practice Address - Zip Code:42701-4470
Practice Address - Country:US
Practice Address - Phone:270-769-0110
Practice Address - Fax:270-765-6953
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-21
Last Update Date:2015-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1596363A00000X
IN10001620A363A00000X
KYPA1835363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN10001620AOtherINDIANA STATE LICENSE
TN1081766OtherNCCPA ID
TN1596OtherTENNESSEE STATE LICENSE NUMBER
KYPA1835OtherKENTUCKY STATE LICENSE
KY12511065OtherCAQH