Provider Demographics
NPI:1437540200
Name:ROSE, BRANDI N (FNP-C)
Entity type:Individual
Prefix:
First Name:BRANDI
Middle Name:N
Last Name:ROSE
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:FULTON
Mailing Address - State:KY
Mailing Address - Zip Code:42041-1601
Mailing Address - Country:US
Mailing Address - Phone:270-472-5245
Mailing Address - Fax:270-472-5249
Practice Address - Street 1:101 MAIN ST
Practice Address - Street 2:
Practice Address - City:FULTON
Practice Address - State:KY
Practice Address - Zip Code:42041-1601
Practice Address - Country:US
Practice Address - Phone:270-472-5245
Practice Address - Fax:270-472-5249
Is Sole Proprietor?:No
Enumeration Date:2015-02-13
Last Update Date:2024-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN19671363LF0000X
KY4015211363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY4015211OtherNP LICENSE KY
KY7100965780Medicaid
TN19671OtherNP LICENSE - TN
TN158274OtherRN LICENSE
TNQ012535Medicaid