Provider Demographics
NPI:1356143663
Name:CONNELL, BRANDY (FNP)
Entity type:Individual
Prefix:
First Name:BRANDY
Middle Name:
Last Name:CONNELL
Suffix:
Gender:
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:404 E 9TH ST
Mailing Address - Street 2:
Mailing Address - City:ADEL
Mailing Address - State:GA
Mailing Address - Zip Code:31620-3583
Mailing Address - Country:US
Mailing Address - Phone:229-237-1175
Mailing Address - Fax:
Practice Address - Street 1:260 MJ TAYLOR RD # 260
Practice Address - Street 2:
Practice Address - City:ADEL
Practice Address - State:GA
Practice Address - Zip Code:31620-3485
Practice Address - Country:US
Practice Address - Phone:229-237-1175
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-26
Last Update Date:2025-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN227295163W00000X
GANCO-000001363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily