Healthcare Provider Details

I. General information

NPI: 1740112267
Provider Name (Legal Business Name): BRENDIAN OZZIE JAMES OSBORN RN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: OZZIE JAMES OSBORN RN

II. Dates (important events)

Enumeration Date: 06/01/2026
Last Update Date: 06/01/2026
Certification Date: 05/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7301 ROGERS AVE
FORT SMITH AR
72903-4100
US

IV. Provider business mailing address

1414 S Q ST APT B
FORT SMITH AR
72901-5423
US

V. Phone/Fax

Practice location:
  • Phone: 479-314-6000
  • Fax:
Mailing address:
  • Phone: 479-314-6000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number224035
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: