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General NPI Number Information
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NPI Number | 1336015312
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Entity Type | Individual
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Provider Name | KATLYN MAEGAN BRANTLEY
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Gender | Female
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Dates
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Enumeration Date | 10/15/2025
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Last Update Date | 10/15/2025
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Provider Practice Location Address
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Address Line | 711 E BOND ST
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City | ESPANOLA
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State | NM
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Zip | 87532-2729
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Country | US
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Telephone | 505-753-9503
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Fax |
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Provider Business Mailing Address
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Address Line | 439 PONDEROSA WAY
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City | JEMEZ SPRINGS
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State | NM
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Zip | 87025-8036
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Country | US
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Telephone | 505-240-0353
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 53897
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License Number State | NM
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