Healthcare Provider Details

I. General information

NPI: 1154574747
Provider Name (Legal Business Name): SUSAN L BRANHAM RN, ANP-BC, PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/28/2008
Last Update Date: 06/20/2025
Certification Date: 06/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

107 W 20TH ST
MOUNT PLEASANT TX
75455-2323
US

IV. Provider business mailing address

107 W 20TH ST
MOUNT PLEASANT TX
75455-2323
US

V. Phone/Fax

Practice location:
  • Phone: 903-575-7856
  • Fax: 903-572-3407
Mailing address:
  • Phone: 903-575-7856
  • Fax: 903-946-5258

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberAP117248
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAP117248
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: