Healthcare Provider Details

I. General information

NPI: 1376452391
Provider Name (Legal Business Name): BRANDON ROBERT HANKINS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/04/2026
Last Update Date: 09/04/2026
Certification Date: 09/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 COFFEE RD
MODESTO CA
95355-4201
US

IV. Provider business mailing address

3425 COFFEE RD
MODESTO CA
95355-1582
US

V. Phone/Fax

Practice location:
  • Phone: 209-550-4747
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95041399
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: