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NPI Code Detail

MEDICARE: LAURA ANN BRANDLE ACNP

MEDICARE: LAURA ANN BRANDLE ACNP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1364SC0200XCritical Care Medicine Clinical Nurse Specialist901455MS
2363LA2100XAcute Care Nurse Practitioner901455MS
3364SA2100XAcute Care Clinical Nurse Specialist901455MS
4363LC0200XCritical Care Medicine Nurse Practitioner901455MS
5364SA2200XAdult Health Clinical Nurse Specialist901455MS
6364SG0600XGerontology Clinical Nurse Specialist901455MS

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1114385721
Entity Type Code : Individual
Provider Name (Legal Business Name) : LAURA ANN BRANDLE ACNP
Provider Business Mailing Address
First Line : 2101 HIGHWAY 90
Second Line :
City : GAUTIER
State : MS
Zip : 39553-5340
Country : US
Telephone Number : 228-497-7576
Fax Number : 228-497-8869
Provider Business Practice Location Address
First Line : 3635 BIENVILLE BLVD
Second Line :
City : OCEAN SPRINGS
State : MS
Zip : 39564-5711
Country : US
Telephone Number : 228-872-1951
Fax Number : 228-875-9998
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/10/2016
Last Update Date : 04/16/2026

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