Healthcare Provider Details

I. General information

NPI: 1962122770
Provider Name (Legal Business Name): REBECCA ANN BRANTLEY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2022
Last Update Date: 04/10/2023
Certification Date: 04/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2021 PERDIDO ST
NEW ORLEANS LA
70112-1352
US

IV. Provider business mailing address

88 5TH AVE
MT PLEASANT SC
29464-2874
US

V. Phone/Fax

Practice location:
  • Phone: 504-568-4750
  • Fax: 504-568-2202
Mailing address:
  • Phone: 504-568-4750
  • Fax: 504-568-2202

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: