Provider Demographics
NPI:1710568027
Name:SMILEY, BRANDON (CHW/CRS)
Entity type:Individual
Prefix:
First Name:BRANDON
Middle Name:
Last Name:SMILEY
Suffix:
Gender:M
Credentials:CHW/CRS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3116 E MORGAN AVE STE B
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47711-4471
Mailing Address - Country:US
Mailing Address - Phone:270-577-6167
Mailing Address - Fax:812-962-9020
Practice Address - Street 1:3116 E MORGAN AVE STE B
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47711-4471
Practice Address - Country:US
Practice Address - Phone:270-577-6167
Practice Address - Fax:812-962-9020
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-19
Last Update Date:2022-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist