1043617855 NPI number — MISS BRANDI LEE KOHN FNP-C

Table of content: MISS BRANDI LEE KOHN FNP-C (NPI 1043617855)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1043617855 NPI number — MISS BRANDI LEE KOHN FNP-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KOHN
Provider First Name:
BRANDI
Provider Middle Name:
LEE
Provider Name Prefix Text:
MISS
Provider Name Suffix Text:
Provider Credential Text:
FNP-C
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1043617855
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/27/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 7987
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MOBILE
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
36670-0987
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
251-633-0573
Provider Business Mailing Address Fax Number:
251-633-7367

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
141 TUSCALOOSA ST.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MOBILE
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
36607-3422
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
251-433-3344
Provider Business Practice Location Address Fax Number:
251-433-4052
Provider Enumeration Date:
11/21/2014

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363L00000X , with the licence number:  1-122336 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LF0000X , with the licence number: 1122336 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 03988710 . This is a "MS MEDICAID" identifier , issued by the state of ( MS ) . This identifiers is of the category "OTHER".
  • Identifier: 221585 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 222626 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: P01472078 . This is a "RR MEDICARE" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 5116736 . This is a "AETNA" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: Z94090 . This is a "VIVA HEALTH" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 213489 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 511-95733 . This is a "BCBS" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 512-06695 . This is a "BCBS" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 102I503889 . This is a "MEDICARE" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 171394 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 214121 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 511-58768 . This is a "BCBS" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 512-06694 . This is a "BCBS" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 5329049 . This is a "UHC" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".




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