Healthcare Provider Details

I. General information

NPI: 1992571442
Provider Name (Legal Business Name): BRANDI NICOLE SCOTT FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/27/2023
Last Update Date: 09/30/2025
Certification Date: 09/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 SCOTTS HILL MEDICAL DR STE 204
WILMINGTON NC
28411
US

IV. Provider business mailing address

PO BOX 936857
ATLANTA GA
31193-6857
US

V. Phone/Fax

Practice location:
  • Phone: 910-662-1960
  • Fax: 910-662-1969
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number5019813
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code163WP2201X
TaxonomyAmbulatory Care Registered Nurse
License Number262065
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: