Individual provider Active NPI

Brandi R. Fletcher, NP

  • Nurse Practitioner
  • Bentonville, AR
National Provider Identifier
1144693979
Registry record updated Dec 4, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
217410 Issued in AR
Practice address
3101 SE 14TH Street
Bentonville, AR 72712-4900
Phone
(479) 986-6199
Fax
(479) 636-0371
NPI assigned
Nov 2, 2015
Last updated
Dec 4, 2023By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 4, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 217410 AR Primary
Registered Nurse 163W00000X R099622 AR

Addresses

Primary practice location

3101 SE 14TH Street
Bentonville, AR 72712-4900

Mailing address

PO Box 776084
Chicago, IL 60677-6084
Phone (314) 543-6979

Other names 1

  • Brandi Ellzey Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AR
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20220114000691 AR Practitioner - Nurse Practitioner 0446642821 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Mercy Hospital RogersGroup PAC ID 3072570142, 5 clinicians

Practice addresses (Care Compare)

3101 SE 14TH St
Bentonville, AR 72712-4900
Phone (479) 631-2100

3101 SE 14TH St Pain Management Highw
Bentonville, AR 72712-4900
Phone 47998661994900

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
R099622ARMDRegistered Nurse

Practice roles

OrganizationSpecialtyStatusNew patients
Anesthesia Services of Benton County PA CurrentSince Jan 1, 2022 Accepting new patients
Mercy Health Northwest Arkansas Communities CurrentSince Dec 1, 2023 Accepting new patients
Mercy Hospital Rogers CurrentSince Jan 10, 2024 Accepting new patients
Mercy Health Northwest Arkansas Communities CurrentSince Dec 1, 2023 Accepting new patients

Locations

3101 SE 14th St
Bentonville, AR 72712
Phone (479) 631-2100

2710 S Rife Medical Ln
Rogers, AR 72758
Phone (479) 636-0200

Interoperability endpoints

  • Direct secure messaging: bellzey806275@directc.mercy.net

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1446422400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1701648000000",
    "number": "1144693979",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 776084",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606776084",
            "telephone_number": "314-543-6979",
            "fax_number": "913-647-4120"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3101 SE 14TH STREET",
            "city": "BENTONVILLE",
            "state": "AR",
            "postal_code": "727124900",
            "telephone_number": "479-986-6199",
            "fax_number": "479-636-0371"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FLETCHER",
        "first_name": "BRANDI",
        "middle_name": "R.",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-11-02",
        "last_updated": "2023-12-04",
        "certification_date": "2023-12-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "AR",
            "license": "217410",
            "primary": true
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "AR",
            "license": "R099622",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "BRANDI",
            "last_name": "ELLZEY",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Bentonville, AR

Sources for this page

Verify at the official NPI Registry.