Provider Demographics
NPI:1013772342
Name:BRANDL, MADELYN BRYAN (PMHNP-BC)
Entity type:Individual
Prefix:MRS
First Name:MADELYN
Middle Name:BRYAN
Last Name:BRANDL
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 792
Mailing Address - Street 2:
Mailing Address - City:BASTROP
Mailing Address - State:LA
Mailing Address - Zip Code:71221-0792
Mailing Address - Country:US
Mailing Address - Phone:318-283-8887
Mailing Address - Fax:
Practice Address - Street 1:1825 N 18TH ST
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71201-4420
Practice Address - Country:US
Practice Address - Phone:318-322-7999
Practice Address - Fax:318-737-7471
Is Sole Proprietor?:No
Enumeration Date:2024-02-15
Last Update Date:2024-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA202759363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health