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General NPI Number Information
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NPI Number | 1912130683
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Entity Type | Individual
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Provider Name | BRANDY R PEACOCK NP
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Gender | Female
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Dates
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Enumeration Date | 08/28/2009
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Last Update Date | 04/01/2013
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Provider Practice Location Address
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Address Line | 200 CORPORATE BLVD SUITE 201
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City | LAFAYETTE
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State | LA
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Zip | 70508-3870
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Country | US
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Telephone | 800-893-9698
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Fax |
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Provider Business Mailing Address
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Address Line | 9107 REDWING CT
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City | SHREVEPORT
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State | LA
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Zip | 71115-3605
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Country | US
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Telephone | 318-840-9660
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | RN085735-AP0589
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License Number State | LA
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | RN085735-AP05893
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License Number State | LA
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