Healthcare Provider Details

I. General information

NPI: 1114963774
Provider Name (Legal Business Name): JIMMY L BRAMLETT CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 GAMBLE DR
LINCOLNTON NC
28092-4421
US

IV. Provider business mailing address

PO BOX 677
LINCOLNTON NC
28093-0677
US

V. Phone/Fax

Practice location:
  • Phone: 704-735-3071
  • Fax: 704-735-0584
Mailing address:
  • Phone: 704-735-3071
  • Fax: 704-735-0584

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number046868
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: