MEDICARE: BRANDI WILLIAMS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106S00000X	Behavior Technician		NV

General Provider Information

NPI Number	:	1871456830
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRANDI WILLIAMS

Provider Business Mailing Address
First Line	:	5350 S PANACA SPRING ST
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89122
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5350 PANACA SPRING ST
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89122-7679
Country	:	US
Telephone Number	:	916-308-7098
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/06/2025
Last Update Date	:	12/10/2025

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