Basic Information
| Provider Information | |||||||||
| NPI: | 1417471103 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PRESTON | ||||||||
| FirstName: | BRANDY | ||||||||
| MiddleName: | COMPTON | ||||||||
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| Credential: | APRN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 358 LEVISA DR | ||||||||
| Address2: | |||||||||
| City: | LOUISA | ||||||||
| State: | KY | ||||||||
| PostalCode: | 412309353 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 94 BOARDWALK | ||||||||
| Address2: | |||||||||
| City: | INEZ | ||||||||
| State: | KY | ||||||||
| PostalCode: | 412247003 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6062982660 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/03/2017 | ||||||||
| LastUpdateDate: | 08/03/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 3011499 | KY | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.