Healthcare Provider Details

I. General information

NPI: 1437930740
Provider Name (Legal Business Name): BRANDY LOUISE CARROLL RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/12/2023
Last Update Date: 10/12/2023
Certification Date: 10/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25201 MO-78
INDEPENDENCE MO
64056
US

IV. Provider business mailing address

19000 E EASTLAND CENTER CT
INDEPENDENCE MO
64055-7022
US

V. Phone/Fax

Practice location:
  • Phone: 816-796-7105
  • Fax:
Mailing address:
  • Phone: 816-478-9299
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License Number2020043111
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: