=====================================================
General NPI Number Information
=====================================================
NPI Number | 1790146454
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | BRANDI ALEXANDER APRN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/09/2016
-----------------------------------------------------
Last Update Date | 03/09/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4301 GREATHOUSE SPRINGS ROAD
-----------------------------------------------------
City | JOHNSON
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72741
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 479-684-3260
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1232 S DINSMORE TRL
-----------------------------------------------------
City | FAYETTEVILLE
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72704-7602
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 479-200-7678
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LW0102X
-----------------------------------------------------
Taxonomy Name | Women's Health Nurse Practitioner
-----------------------------------------------------
License Number | A004684
-----------------------------------------------------
License Number State | AR
-----------------------------------------------------