Individual
BRANDI BURGE WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP-BC
Contact information
Practice address
1225 N STATE ST, JACKSON, MS 39202-2064
(601) 968-1000
Mailing address
313 RED CEDAR DR, BRANDON, MS 39047-4515
(601) 215-0194
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
903822
MS
Other
Enumeration date
02/21/2020
Last updated
02/21/2020
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