Provider Demographics
NPI:1538240296
Name:HERNDON, BRANDY BRYANT (FNP)
Entity type:Individual
Prefix:MRS
First Name:BRANDY
Middle Name:BRYANT
Last Name:HERNDON
Suffix:
Gender:F
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:PO BOX 2109
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29503-2109
Mailing Address - Country:US
Mailing Address - Phone:843-661-0500
Mailing Address - Fax:843-661-7370
Practice Address - Street 1:214 W. PINE ST.
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29501-4725
Practice Address - Country:US
Practice Address - Phone:843-661-0500
Practice Address - Fax:843-661-7370
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2018-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCF1537363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care