Provider Demographics
NPI:1366073785
Name:MEADOWS, BRANDY M
Entity type:Individual
Prefix:
First Name:BRANDY
Middle Name:M
Last Name:MEADOWS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 HIBBARD ST STE 100
Mailing Address - Street 2:
Mailing Address - City:PIKEVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:41501-1788
Mailing Address - Country:US
Mailing Address - Phone:606-433-0404
Mailing Address - Fax:606-432-0405
Practice Address - Street 1:101 HIBBARD ST STE 100
Practice Address - Street 2:
Practice Address - City:PIKEVILLE
Practice Address - State:KY
Practice Address - Zip Code:41501-1788
Practice Address - Country:US
Practice Address - Phone:606-433-0404
Practice Address - Fax:606-432-0405
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-04
Last Update Date:2020-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3014289208VP0000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Multi-Specialty