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NPI Code Detail

MEDICARE: BRANDY CONNELL FNP

MEDICARE: BRANDY CONNELL FNP
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
1163W00000XRegistered NurseRN227295GA
2363LF0000XFamily Nurse PractitionerNCO-000001GA

General Provider Information

NPI Number : 1356143663
Entity Type Code : Individual
Provider Name (Legal Business Name) : BRANDY CONNELL FNP
Provider Business Mailing Address
First Line : 404 E 9TH ST
Second Line :
City : ADEL
State : GA
Zip : 31620-3583
Country : US
Telephone Number : 229-237-1175
Fax Number :
Provider Business Practice Location Address
First Line : 260 MJ TAYLOR RD # 260
Second Line :
City : ADEL
State : GA
Zip : 31620-3485
Country : US
Telephone Number : 229-237-1175
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/26/2025
Last Update Date : 03/26/2025

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