Healthcare Provider Details

I. General information

NPI: 1295349306
Provider Name (Legal Business Name): BRANDI NICOLE MULRYAN APRN/WHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BRANDI NICOLE COON APRN/WHNP-BC

II. Dates (important events)

Enumeration Date: 09/04/2020
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6299 NALL AVE STE 101
MISSION KS
66202-3552
US

IV. Provider business mailing address

5318 BROWNRIDGE DR
SHAWNEE KS
66218-9213
US

V. Phone/Fax

Practice location:
  • Phone: 913-456-3922
  • Fax:
Mailing address:
  • Phone: 913-456-3922
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number53-79667-082
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: