Provider Demographics
NPI:1962168013
Name:JAMISON, BRANDI (APRN)
Entity type:Individual
Prefix:
First Name:BRANDI
Middle Name:
Last Name:JAMISON
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5610 BUNCOMBE RD APT 204
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71129-2687
Mailing Address - Country:US
Mailing Address - Phone:318-518-1049
Mailing Address - Fax:
Practice Address - Street 1:5610 BUNCOMBE RD APT 204
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71129-2687
Practice Address - Country:US
Practice Address - Phone:318-518-1049
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-12
Last Update Date:2021-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA210697363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA210697OtherLOUISIANA STATE BOARD OF NURSING