Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Brandon Blake Teller, FNP-C

Individual provider Critical Care Medicine Registered Nurse · NPI 1285477018

Brandon Blake Teller, FNP-C is a Nurse Practitioner in Vicksburg, Mississippi. Qualified in 2025, 1 year ago. Practices with Vicksburg Clinic LLC, a 27-clinician group and accepts Medicare assignment. Licensed in Mississippi.

Years since qualifying
1
Licensed in
MS
In the registry since
2024
Specialties on file
2
What do these letters mean?
FNP-C — Family Nurse Practitioner, Certified
A family nurse practitioner certified by the AANP.

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Practice location Address checks out

2100 US-61 N
Vicksburg, MS 39183-4500
Phone: (601) 415-6161
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Family Nurse Practitioner (primary) Taxonomy 363LF0000X · Licence F07250420 (MS)
Critical Care Medicine Registered Nurse Taxonomy 163WC0200X · Licence 918907 (MS)

Record details

NPI number1285477018
Entity typeIndividual (Type 1)
GenderMale
Credentials FNP-C
Sole proprietorYes
NPI enumeratedJune 18, 2024
Last updated in NPPESJuly 16, 2025
Certification dateJuly 16, 2025
Mailing address2100 Us-61n, Vicksburg, MS 39183-6094

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyNURSE PRACTITIONER
Medical schoolOTHER
Graduated 2025 (1 years in practice)
Group practice Vicksburg Clinic Llc — 27 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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