Provider Demographics
NPI:1699330670
Name:BAUGH, BRANDY NICHOLE (FNP-C)
Entity type:Individual
Prefix:
First Name:BRANDY
Middle Name:NICHOLE
Last Name:BAUGH
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:BRANDY
Other - Middle Name:NICHOLE
Other - Last Name:HARRIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3001 EDWARDS MILL RD
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27612-5243
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4414 LAKE BOONE TRL STE 505
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27607-7521
Practice Address - Country:US
Practice Address - Phone:919-784-2300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-06
Last Update Date:2022-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC246600363L00000X
NC5011752363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner