Healthcare Provider Details

I. General information

NPI: 1316822471
Provider Name (Legal Business Name): BRANDON DEVANTE MAGEESMITH RN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: BRANDON DEVANTE KAIGLER RN

II. Dates (important events)

Enumeration Date: 08/07/2025
Last Update Date: 08/07/2025
Certification Date: 08/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

218 OLIVE HILL DR
SAN JOSE CA
95125-6600
US

IV. Provider business mailing address

218 OLIVE HILL DR
SAN JOSE CA
95125-6600
US

V. Phone/Fax

Practice location:
  • Phone: 209-650-5607
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP2201X
TaxonomyAmbulatory Care Registered Nurse
License Number95317653
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: