Healthcare Provider Details

I. General information

NPI: 1992178958
Provider Name (Legal Business Name): ANGELA BRATTON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/12/2015
Last Update Date: 11/12/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1219 ROCKINGHAM DR
CLINTON MS
39056-3543
US

IV. Provider business mailing address

1219 ROCKINGHAM DR
CLINTON MS
39056-3543
US

V. Phone/Fax

Practice location:
  • Phone: 601-937-0012
  • Fax: 601-510-9242
Mailing address:
  • Phone: 601-937-0012
  • Fax: 601-510-9242

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: