Provider Demographics
NPI:1245733260
Name:FORD, BRANDY SHERELL
Entity type:Individual
Prefix:
First Name:BRANDY
Middle Name:SHERELL
Last Name:FORD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 CREPE MYRTLE LN
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75604-6908
Mailing Address - Country:US
Mailing Address - Phone:903-445-3664
Mailing Address - Fax:
Practice Address - Street 1:901 CREPE MYRTLE LN
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75604-6908
Practice Address - Country:US
Practice Address - Phone:903-445-3664
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-15
Last Update Date:2018-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX336320164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse