Brandy Ladora Macon, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

2017025341 Issued in MO

Practice address

4414 N Florissant Ave
Saint Louis, MO 63107-1812

Phone

(314) 814-8700

Fax

(314) 898-1773

NPI assigned

Jul 24, 2017

Sex

Female

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Other names 1

• Miss Brandy Macon Eugene Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

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

{
    "created_epoch": "1500854400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1285157958",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4414 N FLORISSANT AVE",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631071812",
            "telephone_number": "314-814-8700",
            "fax_number": "314-898-1773"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4414 N FLORISSANT AVE",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631071812",
            "telephone_number": "314-814-8700",
            "fax_number": "314-898-1773"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MACON",
        "first_name": "BRANDY",
        "middle_name": "LADORA",
        "name_prefix": "Mrs.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-07-24",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "IL",
            "license": "085006152",
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MO",
            "license": "2017025341",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "BRANDY",
            "last_name": "EUGENE",
            "middle_name": "MACON",
            "prefix": "MISS",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Katherine Macleod, LCSW
• Spencer Barrington Macleod, MD
• Melvin Marlow Maclin II, M.D.
• Brandi Macmanus, BS
• McKenzie Dee Macmillan
• Brittany Macon
• June Macon, RN
• Elizabeth E Maconachy, PT DPT
• George A Macones, MD
• Lauren Ashley Macy, AGACNP-BC

• Physician Assistant in Saint Louis, MO
• Providers in Saint Louis, MO by specialty
• Physician Assistant in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.