Healthcare Provider Details

I. General information

NPI: 1114858719
Provider Name (Legal Business Name): BRANDY JOY HAYMAKER FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/25/2026
Last Update Date: 05/25/2026
Certification Date: 05/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23 UPPER PLN
BRADFORD VT
05033-9016
US

IV. Provider business mailing address

23 UPPER PLN
BRADFORD VT
05033-9016
US

V. Phone/Fax

Practice location:
  • Phone: 802-222-5201
  • Fax: 855-945-4315
Mailing address:
  • Phone: 802-222-5201
  • Fax: 855-945-4315

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number101.0139396
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: