Basic Information
| Provider Information | |||||||||
| NPI: | 1265661698 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | STINSON | ||||||||
| FirstName: | BRANDY | ||||||||
| MiddleName: | D | ||||||||
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| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 776351 | ||||||||
| Address2: | |||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606776351 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5025889490 | ||||||||
| FaxNumber: | 5022725116 | ||||||||
| Practice Location | |||||||||
| Address1: | 200 EAST CHESTNUT STREET, SERVICE BUILDING | ||||||||
| Address2: | SUITE 303 | ||||||||
| City: | LOUISVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 402021831 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5026295552 | ||||||||
| FaxNumber: | 5026293132 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/07/2009 | ||||||||
| LastUpdateDate: | 12/22/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/22/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | 1086032 | KY | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
ID Information
| ID | Type | State | Issuer | Description | 200962900 | 01 | IN | HEALTHY INDIANA PLAN (THRU MD WISE)- CARDIOTHORACIC SURGERY OF LOUISVILLE | OTHER | 000000630697 | 01 | KY | ANTHEM- CARDIOTHORACIC SURGERY OF LOUISVILLE | OTHER | 000051983V | 01 | KY | HUMANA- CARDIOTHORACIC SURGERY OF LOUISVILLE | OTHER | 200962900 | 01 | IN | HEALTHY INDIANA PLAN (THRU ANTHEM)- CARDIOTHORACIC SURGERY OF LOUISVILLE | OTHER | 3737982000 | 01 | KY | PASSPORT ADVANTAGE- CARDIOTHORACIC SURGERY OF LOUISVILLE | OTHER | 200962900 | 01 | IN | ANTHEM INDIANA MEDICAID- CARDIOTHORACIC SURGERY OF LOUISVILLE | OTHER | 50025831 | 01 | KY | PASSPORT- CARDIOTHORACIC SURGERY OF LOUISVILLE | OTHER | 7100086960 | 05 | KY | MEDICAID | 200962900 | 01 | KY | MANAGED HEALTH SERVICES- CARDIOTHORACIC SURGERY OF LOUISVILLE | OTHER | 200962900 | 05 | IN | MEDICAID |