Healthcare Provider Details

I. General information

NPI: 1164673786
Provider Name (Legal Business Name): MS. BRANDI JO HAMPSHIRE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: BRANDI JO HIXENBAUGH

II. Dates (important events)

Enumeration Date: 10/01/2008
Last Update Date: 11/16/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

166 RACHELLE PL
BAXTER TN
38544-2000
US

IV. Provider business mailing address

166 RACHELLE PL
BAXTER TN
38544-2000
US

V. Phone/Fax

Practice location:
  • Phone: 931-265-9373
  • Fax:
Mailing address:
  • Phone: 931-265-9373
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: