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NPI Code Detail

MEDICARE: BRANDY ALEXANDRA RUTLAND PMHNP-BC

MEDICARE: BRANDY ALEXANDRA RUTLAND PMHNP-BC
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
1363LP0808XPsychiatric/Mental Health Nurse Practitioner904379MS

General Provider Information

NPI Number : 1225628761
Entity Type Code : Individual
Provider Name (Legal Business Name) : BRANDY ALEXANDRA RUTLAND PMHNP-BC
Provider Business Mailing Address
First Line : 1020 CUMBERLAND DR
Second Line :
City : BRANDON
State : MS
Zip : 39047-7903
Country : US
Telephone Number : 601-951-8993
Fax Number :
Provider Business Practice Location Address
First Line : 1059 RIDGEWOOD PL
Second Line :
City : JACKSON
State : MS
Zip : 39211-2018
Country : US
Telephone Number : 601-957-3211
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/19/2021
Last Update Date : 01/19/2021

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