Individual
BRANDON BLAKE TELLER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
FNP-C
Contact information
Practice address
2100 US-61 N, VICKSBURG, MS 39183-4500
(601) 415-6161
Mailing address
2100 US-61N, VICKSBURG, MS 39183-6094
(601) 415-6161
Taxonomy
Speciality
Code
Description
License number
State
163WC0200X
Critical Care Medicine Registered Nurse
918907
MS
363LF0000X
Family Nurse Practitioner
Primary
F07250420
MS
Other
Enumeration date
06/18/2024
Last updated
07/16/2025
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