Healthcare Provider Details

I. General information

NPI: 1417894940
Provider Name (Legal Business Name): BRANDY WADSWORTH NURSE PRACTITIONER IN PSYCHIATRY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/01/2026
Last Update Date: 05/01/2026
Certification Date: 05/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

221 MAIN STREET SUITE 2
HUDSON FALLS NY
12839
US

IV. Provider business mailing address

2 BURGOYNE AVE
FORT EDWARD NY
12828-1511
US

V. Phone/Fax

Practice location:
  • Phone: 518-599-8460
  • Fax: 253-366-8595
Mailing address:
  • Phone: 518-505-9414
  • Fax: 253-366-8595

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number StateNULL

VIII. Authorized Official

Name: BRANDY WADSWORTH
Title or Position: OWNER/PRACTITIONER
Credential: PMHNP-BC
Phone: 518-505-9414