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Individual
BRANDON GARY ALLEN
Active
Individual
BRANDON GARY ALLEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
FNP-C, PMHNP-BC
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
876372
MS
363LF0000X
Family Nurse Practitioner
902766
MS
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
902766
MS
Other
Enumeration date
08/01/2018
Last updated
04/17/2024
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