Healthcare Provider Details

I. General information

NPI: 1265969380
Provider Name (Legal Business Name): SHENISE NICOLE BRATTON FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/19/2017
Last Update Date: 03/06/2025
Certification Date: 03/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4938 S STAPLES ST STE E8
CORPUS CHRISTI TX
78411-3836
US

IV. Provider business mailing address

14500 DALLAS PKWY APT 183
DALLAS TX
75254-8312
US

V. Phone/Fax

Practice location:
  • Phone: 361-452-9620
  • Fax:
Mailing address:
  • Phone: 314-814-6320
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number239660
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP134008
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: