Brandon Blake Teller, FNP-C
Individual provider Active NPI Family Nurse Practitioner · Vicksburg, MS
NPI 1285477018 · NPPES record last updated Jul 16, 2025
Key facts
- NPI
- 1285477018
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Nurse Practitioner 363LF0000X
- License
- F07250420 (MS)
- Practice address
- 2100 US-61 N
Vicksburg, MS 39183-4500 - Phone
- (601) 415-6161
- NPI assigned
- Jun 18, 2024
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 5
Hospital & facility affiliations 2
Medicare Care Compare profile
- Specialty
- Nurse Practitioner
- Education
- Other, 2025
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Vicksburg Clinic LLC
Practice addresses (Care Compare)
2200 Hwy 61 N
FL 1
Vicksburg, MS 39183-8246
Phone (601) 883-6092
Hospital & facility affiliations
- Enhabit Home Health
- Merit Health River Region
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MS
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20250925004715 | MS | Practitioner - Nurse Practitioner | 4880199280 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 918907 | MS | MD | Critical Care Medicine Registered Nurse |
| F07250420 | MS | MD | Family Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Vicksburg Clinic LLC | Multi-Specialty | Current |
Accepting new patients |
| Vicksburg Clinic LLC | Multi-Specialty | Past |
Accepting new patients |
| Vicksburg Clinic LLC | Multi-Specialty | Past | Accepting new patients |
Locations
2100 Highway 61 N
Vicksburg, MS 39183
Phone (601) 883-5001
104 McAuley Dr
Vicksburg, MS 39183
Phone (601) 638-7271
2200 Highway 61 N
Ste 1400
Vicksburg, MS 39183
Phone (601) 883-3391
2200 Highway 61 N
Fl 1
Vicksburg, MS 39183
Phone (601) 883-6092
Interoperability endpoints
- brandon.teller.1@1475.direct.athenahealth.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Critical Care Medicine Registered Nurse |
163WC0200X | 918907 | MS | |
| Family Nurse Practitioner | 363LF0000X | F07250420 | MS | Yes |
Addresses
Primary practice location
2100 US-61 N
Vicksburg, MS 39183-4500
Mailing address
2100 US-61N
Vicksburg, MS 39183-6094
Phone (601) 415-6161
Other providers in Vicksburg, MS
- Jalia Deneicia Tarleton
- Darren R Tate
- Charles Glenn Taylor
- Denetra Quinnette Taylor
- Kisa Taylor
- Linda S Tello
- The Akeso Group - Vicksburg
- The Bluffs Rehabilitation and Healthcare Center, LLC
- The Lauren Forte Hair Loss Replacement Center
- The Life Balance Clinic, Behavioral Health Service
All providers in Vicksburg, MS · Family Nurse Practitioner in Mississippi
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 16, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.