Active NPI
Brandi Herron
- Periodontics
- Lafayette, IN
National Provider Identifier
1922684844
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Periodontics
- License
- 12013395A
- Practice address
- 415 N 26TH St Ste 303
Lafayette, IN 47904-2893 - Phone
- (654) 479-3197
- NPI assigned
- Mar 22, 2021
- Last updated
- Sep 5, 2023
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Periodontics | 1223P0300X | 12013395A | IN | Primary |
Addresses
Primary practice location
415 N 26TH St Ste 303
Lafayette, IN 47904-2893
Mailing address
415 N 26TH St Ste 303
Lafayette, IN 47904-2893
Phone (765) 447-9319
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Oct 16, 2023 through Oct 16, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 12013395A | IN | MD | Periodontist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1616371200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1693872000000",
"number": "1922684844",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "415 N 26TH ST STE 303",
"city": "LAFAYETTE",
"state": "IN",
"postal_code": "479042893",
"telephone_number": "765-447-9319",
"fax_number": "765-447-7227"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "415 N 26TH ST STE 303",
"city": "LAFAYETTE",
"state": "IN",
"postal_code": "479042893",
"telephone_number": "654-479-3197"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HERRON",
"first_name": "BRANDI",
"name_prefix": "Dr.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2021-03-22",
"last_updated": "2023-09-05",
"certification_date": "2023-09-05",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0300X",
"taxonomy_group": "",
"desc": "Dentist, Periodontics",
"state": "IN",
"license": "12013395A",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lafayette, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 5, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.