Healthcare Provider Details

I. General information

NPI: 1871434977
Provider Name (Legal Business Name): EXTENDED HAIR BY BRANDI LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/02/2026
Last Update Date: 04/02/2026
Certification Date: 04/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

416 E BROADWAY
COLUMBIA MO
65201-4438
US

IV. Provider business mailing address

416 E BROADWAY
COLUMBIA MO
65201-4438
US

V. Phone/Fax

Practice location:
  • Phone: 573-441-2322
  • Fax: 573-441-2322
Mailing address:
  • Phone: 573-441-2322
  • Fax: 573-441-2322

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: BRANDI HARRIS
Title or Position: CEO
Credential:
Phone: 573-818-8554