Healthcare Provider Details

I. General information

NPI: 1649423237
Provider Name (Legal Business Name): DANA BRANTLEY APN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/28/2008
Last Update Date: 03/10/2025
Certification Date: 03/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5002 HIGHWAY 39 N BLDG C
MERIDIAN MS
39301-1078
US

IV. Provider business mailing address

670 LEIGH DR
COLUMBUS MS
39705-3014
US

V. Phone/Fax

Practice location:
  • Phone: 601-385-9111
  • Fax: 662-328-1507
Mailing address:
  • Phone: 662-328-1012
  • Fax: 662-328-1507

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAP127550
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number903935
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: