Basic Information
| Provider Information | |||||||||
| NPI: | 1669124814 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CLARY | ||||||||
| FirstName: | BRANDY | ||||||||
| MiddleName: | LYNN | ||||||||
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| Credential: | MSN, APRN, FNP-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 42ND MEDICAL GROUP | ||||||||
| Address2: | 300 SOUTH TWINING STREET, BLDG 760 | ||||||||
| City: | MAXWELL AFB | ||||||||
| State: | AL | ||||||||
| PostalCode: | 36112 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2282293491 | ||||||||
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| Practice Location | |||||||||
| Address1: | 42ND MEDICAL GROUP | ||||||||
| Address2: | 300 SOUTH TWINING STREET, BLDG 760 | ||||||||
| City: | MAXWELL AFB | ||||||||
| State: | AL | ||||||||
| PostalCode: | 36112 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3349535200 | ||||||||
| FaxNumber: | 3349538607 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/19/2022 | ||||||||
| LastUpdateDate: | 06/09/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/03/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 2020011332 | MO | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.