Healthcare Provider Details

I. General information

NPI: 1386384725
Provider Name (Legal Business Name): BREANNE PARETS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/01/2022
Last Update Date: 04/01/2022
Certification Date: 04/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 FISHER ST, RM 5A127
KEESLER AFB MS
39534
US

IV. Provider business mailing address

301 FISHER ST, RM 5A127
KEESLER AFB MS
39534
US

V. Phone/Fax

Practice location:
  • Phone: 228-376-3092
  • Fax:
Mailing address:
  • Phone:
  • Fax:

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: