Individual
BRANDI MANGAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP-C
Contact information
Practice address
650 JOEL DR, FORT CAMPBELL, KY 42223-5318
(270) 798-8372
Mailing address
650 JOEL DR, FORT CAMPBELL, KY 42223-5318
(270) 798-8372
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
27196
TN
363LF0000X
Family Nurse Practitioner
Primary
3014404
KY
Other
Enumeration date
11/04/2020
Last updated
11/04/2020
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