Healthcare Provider Details

I. General information

NPI: 1578082251
Provider Name (Legal Business Name): BRANDI R BARNES FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BRANDI R HURDLE FNP

II. Dates (important events)

Enumeration Date: 09/14/2017
Last Update Date: 01/10/2023
Certification Date: 01/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14884 HIGHWAY 15
DECATUR MS
39327
US

IV. Provider business mailing address

826 REYNOLDS RD
FOREST MS
39074-8559
US

V. Phone/Fax

Practice location:
  • Phone: 601-635-2258
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number902275
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: