Provider Demographics
NPI:1962156190
Name:DAVIS, BRANDILYN RENE (PMHNP-BC)
Entity type:Individual
Prefix:
First Name:BRANDILYN
Middle Name:RENE
Last Name:DAVIS
Suffix:
Gender:
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:609 BRUNSON DR STE B
Mailing Address - Street 2:
Mailing Address - City:TUPELO
Mailing Address - State:MS
Mailing Address - Zip Code:38801-4948
Mailing Address - Country:US
Mailing Address - Phone:662-432-1097
Mailing Address - Fax:833-707-1951
Practice Address - Street 1:1020 HIGHWAY 62 E
Practice Address - Street 2:
Practice Address - City:MOUNTAIN HOME
Practice Address - State:AR
Practice Address - Zip Code:72653-3216
Practice Address - Country:US
Practice Address - Phone:870-337-2172
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-07
Last Update Date:2025-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS2023192642363L00000X, 363LP0808X
MS905144363LF0000X, 363LP2300X
AR232613363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS03851554Medicaid