Provider Demographics
NPI:1447060017
Name:SMITH, BRANDIE LATISSE (DNP, APRN, WHNP)
Entity type:Individual
Prefix:
First Name:BRANDIE
Middle Name:LATISSE
Last Name:SMITH
Suffix:
Gender:F
Credentials:DNP, APRN, WHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7927 FLOYD ST STE 2
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66204-3724
Mailing Address - Country:US
Mailing Address - Phone:816-651-4194
Mailing Address - Fax:
Practice Address - Street 1:7927 FLOYD ST STE 2
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66204-3724
Practice Address - Country:US
Practice Address - Phone:816-651-4194
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-07
Last Update Date:2025-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSTMP-162554363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health