Healthcare Provider Details

I. General information

NPI: 1205030335
Provider Name (Legal Business Name): SANDY MICHELE BRANSON APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/13/2007
Last Update Date: 11/30/2025
Certification Date: 11/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1970 E JOYCE BLVD STE 2
FAYETTEVILLE AR
72703-5135
US

IV. Provider business mailing address

PO BOX 12
WINSLOW AR
72959-0012
US

V. Phone/Fax

Practice location:
  • Phone: 479-265-5198
  • Fax: 479-339-3077
Mailing address:
  • Phone: 479-601-6201
  • Fax: 479-339-3077

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberA02935
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR66717
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: