Individual provider Active NPI

Brandi R Henry, FNP

  • Family Nurse Practitioner
  • Jackson, TN
National Provider Identifier
1831430560
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
0000017372 Issued in TN
Practice address
160 W University Pkwy Ste C
Jackson, TN 38305-1667
Phone
(731) 660-5116
Fax
(731) 660-5119
NPI assigned
Mar 5, 2013
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 0000017372 TN Primary

Addresses

Primary practice location

160 W University Pkwy Ste C
Jackson, TN 38305-1667

Mailing address

6263 Poplar Ave Ste 1032
Memphis, TN 38119-4743
Phone (731) 400-0411

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN, MS2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20140819001084 TN Practitioner - Nurse Practitioner 3274750039 Reassigns benefits to 1 organization
I20150506001474 MS Practitioner - Nurse Practitioner 3274750039 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Mississippi Pain Institute Corinth PLLCGroup PAC ID 5496236499, 5 clinicians

Practice addresses (Care Compare)

3037 Corder Dr
Corinth, MS 38834-6216
Phone (769) 229-3758

Hospital & facility affiliations

  • Magnolia Regional Health Center Hospital, Corinth, MS, CCN 250009
  • Baptist Memorial Hospital Booneville Hospital, Booneville, MS, CCN 250044
  • Baptist Memorial Hospital Hospital, Memphis, TN, CCN 440048

Merit-based Incentive Payment System (MIPS)

Final score
23.47 of 100Reported as individual
Quality
0
Improvement activities
0
Cost
78.24

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
0000017372TNMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Fast Pace Medical Clinic PLLC CurrentSince Mar 11, 2019 Accepting new patients
Fast Pace Medical Clinic PLLC CurrentSince Mar 11, 2019 Accepting new patients
Mississippi Pain Institute Corinth PLLC CurrentSince Apr 1, 2026 Accepting new patients

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 and National Provider Directory roles.

Hospital & facility affiliations 3

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": "1362441600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1831430560",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6263 POPLAR AVE STE 1032",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "381194743",
            "telephone_number": "731-400-0411",
            "fax_number": "901-779-6968"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "160 W UNIVERSITY PKWY STE C",
            "city": "JACKSON",
            "state": "TN",
            "postal_code": "383051667",
            "telephone_number": "731-660-5116",
            "fax_number": "731-660-5119"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HENRY",
        "first_name": "BRANDI",
        "middle_name": "R",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-03-05",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "TN",
            "license": "0000017372",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Jackson, TN

Sources for this page

Verify at the official NPI Registry.