Basic Information
| Provider Information | |||||||||
| NPI: | 1831633403 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RAY | ||||||||
| FirstName: | BRANDI | ||||||||
| MiddleName: | SHARP | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1751 VETERANS DR STE 300 | ||||||||
| Address2: | |||||||||
| City: | FLORENCE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 356304930 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2567183200 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1751 VETERANS DR STE 300 | ||||||||
| Address2: | |||||||||
| City: | FLORENCE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 356304930 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2567183200 | ||||||||
| FaxNumber: | 2562463297 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/15/2016 | ||||||||
| LastUpdateDate: | 06/30/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/30/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 1-138777 | AL | N | Nursing Service Providers | Registered Nurse | 363LA2200X | 1-138777 | AL | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Adult Health |
ID Information
| ID | Type | State | Issuer | Description | 1-138777 | 01 | AL | MEDICAL LICENSE | OTHER |