Provider Demographics
NPI:1538031083
Name:THOMAS, BRANDI
Entity type:Individual
Prefix:
First Name:BRANDI
Middle Name:
Last Name:THOMAS
Suffix:
Gender:X
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1403 OLD WATER WORKS RD SW
Mailing Address - Street 2:
Mailing Address - City:FORT PAYNE
Mailing Address - State:AL
Mailing Address - Zip Code:35968-3353
Mailing Address - Country:US
Mailing Address - Phone:256-646-7246
Mailing Address - Fax:256-304-5333
Practice Address - Street 1:1403 OLD WATER WORKS RD SW
Practice Address - Street 2:
Practice Address - City:FORT PAYNE
Practice Address - State:AL
Practice Address - Zip Code:35968-3353
Practice Address - Country:US
Practice Address - Phone:256-646-7246
Practice Address - Fax:256-304-5333
Is Sole Proprietor?:No
Enumeration Date:2025-09-23
Last Update Date:2025-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-136761363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily