Provider Demographics
NPI:1083250450
Name:MCCRUDDEN, BRANDY (DNP, PMHNP-BC)
Entity type:Individual
Prefix:
First Name:BRANDY
Middle Name:
Last Name:MCCRUDDEN
Suffix:
Gender:F
Credentials:DNP, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6811 167TH ST UNIT 2
Mailing Address - Street 2:
Mailing Address - City:TINLEY PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60477-2501
Mailing Address - Country:US
Mailing Address - Phone:708-232-8854
Mailing Address - Fax:708-854-0714
Practice Address - Street 1:6811 167TH ST UNIT 2
Practice Address - Street 2:
Practice Address - City:TINLEY PARK
Practice Address - State:IL
Practice Address - Zip Code:60477-2501
Practice Address - Country:US
Practice Address - Phone:708-232-8854
Practice Address - Fax:708-854-0714
Is Sole Proprietor?:No
Enumeration Date:2019-11-20
Last Update Date:2025-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL277004256363L00000X, 363LF0000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily