Individual
BRANDY LEE VINES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2103 SLACK ST, PEA RIDGE, AR 72751-4005
(765) 479-1980
Mailing address
2103 SLACK ST, PEA RIDGE, AR 72751-4005
(479) 756-1980
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
227730
AR
Other
Enumeration date
02/23/2024
Last updated
02/23/2024
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