Provider Demographics
NPI:1144693979
Name:FLETCHER, BRANDI R (NP)
Entity type:Individual
Prefix:
First Name:BRANDI
Middle Name:R
Last Name:FLETCHER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:BRANDI
Other - Middle Name:
Other - Last Name:ELLZEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 776084
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-6084
Mailing Address - Country:US
Mailing Address - Phone:314-543-6979
Mailing Address - Fax:913-647-4120
Practice Address - Street 1:3101 SE 14TH STREET
Practice Address - Street 2:
Practice Address - City:BENTONVILLE
Practice Address - State:AR
Practice Address - Zip Code:72712-4900
Practice Address - Country:US
Practice Address - Phone:479-986-6199
Practice Address - Fax:479-636-0371
Is Sole Proprietor?:No
Enumeration Date:2015-11-02
Last Update Date:2023-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARR099622163W00000X
AR217410363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse