Basic Information
Provider Information
NPI: 1811462138
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: MAYS
FirstName: BRANDI
MiddleName: L
NamePrefix:  
NameSuffix:  
Credential: APRN, CNP
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 83
Address2:  
City: CORNING
State: AR
PostalCode: 724220083
CountryCode: US
TelephoneNumber: 8708573334
FaxNumber: 8708579934
Practice Location
Address1: 141 BETTY DR
Address2:  
City: POCAHONTAS
State: AR
PostalCode: 724553602
CountryCode: US
TelephoneNumber: 8708929949
FaxNumber: 8708920208
Other Information
ProviderEnumerationDate: 10/12/2018
LastUpdateDate: 08/22/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 08/22/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363LF0000XA005942ARY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily

No ID Information.


Home