Provider Demographics
NPI:1023152030
Name:FARRELL, BRANDI DENNISON (MSN ,CPNP- AC,PC)
Entity type:Individual
Prefix:
First Name:BRANDI
Middle Name:DENNISON
Last Name:FARRELL
Suffix:
Gender:F
Credentials:MSN ,CPNP- AC,PC
Other - Prefix:
Other - First Name:BRANDI
Other - Middle Name:CHARMAINE
Other - Last Name:DENNISON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSN, CPNP
Mailing Address - Street 1:PO BOX 110429
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80042-0429
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:13123 E 16TH AVE
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80045-7106
Practice Address - Country:US
Practice Address - Phone:720-777-1234
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-16
Last Update Date:2023-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00093600363LP0200X
TXAP121065363LP0200X
PASP008101363LP0200X
COC-APN.0100784-C-NP363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX288036101Medicaid
TX288036102OtherCSHCN
TX288036105Medicaid