Healthcare Provider Details

I. General information

NPI: 1164057857
Provider Name (Legal Business Name): BRANDI BRIGGS WILSON NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/03/2020
Last Update Date: 01/22/2022
Certification Date: 01/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

590 MEDICAL PARK DR
MARSHALL NC
28753-6807
US

IV. Provider business mailing address

199 CATTAIL CREEK RD
BURNSVILLE NC
28714-6871
US

V. Phone/Fax

Practice location:
  • Phone: 828-649-0800
  • Fax:
Mailing address:
  • Phone: 828-536-0023
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number5012934
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: