Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LC0200X | Nurse Practitioner - Critical Care Medicine | 217192 | AR |
NPI | 1336817402 |
---|---|
Provider Name | Brandy L. Baccus |
First Address | Sherwood, AR 72120-3112 |
Second Address | Little Rock, AR 72205-6321 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/09/2021 |
Last Update Date | 02/09/2021 |