Provider Demographics
NPI:1154562742
Name:MCCULLOUGH, BRANDY S (CRNA)
Entity type:Individual
Prefix:
First Name:BRANDY
Middle Name:S
Last Name:MCCULLOUGH
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:BRANDY
Other - Middle Name:S
Other - Last Name:JONES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:PO BOX 2668
Mailing Address - Street 2:
Mailing Address - City:HAMMOND
Mailing Address - State:LA
Mailing Address - Zip Code:70404-2668
Mailing Address - Country:US
Mailing Address - Phone:985-230-1682
Mailing Address - Fax:985-230-6652
Practice Address - Street 1:15790 PAUL VEGA MD DR
Practice Address - Street 2:
Practice Address - City:HAMMOND
Practice Address - State:LA
Practice Address - Zip Code:70403-1434
Practice Address - Country:US
Practice Address - Phone:985-230-2198
Practice Address - Fax:985-230-2159
Is Sole Proprietor?:No
Enumeration Date:2009-03-12
Last Update Date:2025-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP05699367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered