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General NPI Number Information
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NPI Number | 1801145321
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Entity Type | Individual
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Provider Name | FAYE ALICIA BRANUM PA
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Gender | Female
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Dates
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Enumeration Date | 08/29/2012
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Last Update Date | 09/17/2024
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Provider Practice Location Address
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Address Line | 2865 CHURN CREEK RD
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City | REDDING
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State | CA
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Zip | 96002-1117
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Country | US
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Telephone | 530-226-7419
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Fax | 530-224-9433
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Provider Business Mailing Address
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Address Line | 2165 LARKSPUR LN
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City | REDDING
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State | CA
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Zip | 96002-0600
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Country | US
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Telephone | 618-303-6878
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 2012025737
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA52974
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 364SP0808X
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Taxonomy Name | Psychiatric/Mental Health Clinical Nurse Specialist
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License Number | 52974
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License Number State | CA
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Taxonomy #4
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 52974
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License Number State | CA
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