Healthcare Provider Details

I. General information

NPI: 1184998742
Provider Name (Legal Business Name): BRANDY LEIGH FARMER FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/29/2012
Last Update Date: 04/30/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

410 S HERLONG AVE STE 106
ROCK HILL SC
29732-8350
US

IV. Provider business mailing address

410 S HERLONG AVE STE 106
ROCK HILL SC
29732-8350
US

V. Phone/Fax

Practice location:
  • Phone: 803-329-3899
  • Fax: 803-327-3438
Mailing address:
  • Phone: 803-329-3899
  • Fax: 803-327-3438

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number17739
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: