=====================================================
General NPI Number Information
=====================================================
NPI Number | 1659154375
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | BRANDI JO PARKER MSN, FNP-BC, FNP-C
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/16/2023
-----------------------------------------------------
Last Update Date | 11/23/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2901B RAINBOW DR
-----------------------------------------------------
City | RAINBOW CITY
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35906-5817
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 256-240-0927
-----------------------------------------------------
Fax | 833-618-0191
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 651 MAIN ST STE 159
-----------------------------------------------------
City | GARDENDALE
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35071-2793
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 205-583-4673
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | 1-105001
-----------------------------------------------------
License Number State | AL
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | 1-1050001
-----------------------------------------------------
License Number State | AL
-----------------------------------------------------