Healthcare Provider Details

I. General information

NPI: 1104107630
Provider Name (Legal Business Name): BRANDY MARIE HEINRICH FNP BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/29/2011
Last Update Date: 11/06/2024
Certification Date: 11/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1750 ELTON RD
JENNINGS LA
70546-3632
US

IV. Provider business mailing address

1750 ELTON RD
JENNINGS LA
70546-3632
US

V. Phone/Fax

Practice location:
  • Phone: 337-329-6565
  • Fax: 337-329-6575
Mailing address:
  • Phone: 337-329-6565
  • Fax: 337-329-6575

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberAP06539
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP06539
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: