Provider Demographics
NPI:1972171734
Name:CLAVIJO, BRANDIA NICOLE (RN)
Entity type:Individual
Prefix:
First Name:BRANDIA
Middle Name:NICOLE
Last Name:CLAVIJO
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:180 LUCKY MAN WAY
Mailing Address - Street 2:
Mailing Address - City:HARRODSBURG
Mailing Address - State:KY
Mailing Address - Zip Code:40330-8978
Mailing Address - Country:US
Mailing Address - Phone:859-734-2953
Mailing Address - Fax:859-734-4670
Practice Address - Street 1:180 LUCKY MAN WAY
Practice Address - Street 2:
Practice Address - City:HARRODSBURG
Practice Address - State:KY
Practice Address - Zip Code:40330-8978
Practice Address - Country:US
Practice Address - Phone:859-734-2953
Practice Address - Fax:859-734-4670
Is Sole Proprietor?:No
Enumeration Date:2021-06-16
Last Update Date:2021-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1164157364SL0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SL0600XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistLong-Term Care