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Brandi Fennell Smith

Nurse Practitioner

Physician Assistants & Advanced Practice Nursing Providers

5001 Hardy St, Hattiesburg, MS 39402-1308

PECOS Enrollment

This provider is enrolled in PECOS as BRANDI SMITH.

Based on the most recent information from CMS, provider Brandi Fennell Smith is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.

Part B
Medicare Part B
Enrolled
HHA
Home Health Agency
Enrolled
DME
Durable Medical Equipment
Enrolled
PMD
Power Mobility Device
Enrolled

CMS last updated its PECOS records 6 days ago.

Profile Details

Provider ID
1992549463
Provider Type
Individual
Full Name
Smith, Brandi Fennell
Title
Mrs.
Credential
FNP-C

Gender
Female
Sole Proprietor
No
Enumeration Date
6/20/2024
Last Updated
6/20/2024

Contact Information

Practice Location

5001 Hardy St, Hattiesburg, MS 39402-1308

(601) 268-8000

Unlisted Fax

Mailing Location

14 E Spruce, Sumrall, MS 39482-5476

(256) 740-2632

Unlisted Fax

Provider Taxonomies

Code	Description	License
Code 363LF0000X Primary	Description Nurse Practitioner Physician Assistants & Advanced Practice Nursing Providers	License 906743 Mississippi

Brandi Fennell Smith

PECOS Enrollment

Profile Details

Contact Information

Practice Location

Mailing Location

Provider Taxonomies

Code

Description

License

Code

Description

License

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Boyette, Aleza Marie

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Dawson, Cynthia

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Wallace, Susan R