Basic Information
| Provider Information | |||||||||
| NPI: | 1972025179 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HABKOUK | ||||||||
| FirstName: | BRANDON | ||||||||
| MiddleName: | C | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | DNP, APRN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5050 POPLAR AVE STE 800 | ||||||||
| Address2: | |||||||||
| City: | MEMPHIS | ||||||||
| State: | TN | ||||||||
| PostalCode: | 381570800 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9012762662 | ||||||||
| FaxNumber: | 9012742033 | ||||||||
| Practice Location | |||||||||
| Address1: | 5050 POPLAR AVE STE 800 | ||||||||
| Address2: | |||||||||
| City: | MEMPHIS | ||||||||
| State: | TN | ||||||||
| PostalCode: | 381570800 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9012762662 | ||||||||
| FaxNumber: | 9012742033 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/10/2017 | ||||||||
| LastUpdateDate: | 06/09/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 06/09/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 191357 | TN | N | Nursing Service Providers | Registered Nurse | 363LA2100X | 22919 | TN | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Acute Care |
No ID Information.