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General NPI Number Information
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NPI Number | 1871117580
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Entity Type | Organization
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Legal Business Name | SUSAN BRANHAM
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Dates
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Enumeration Date | 05/29/2020
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Last Update Date | 05/29/2020
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Provider Practice Location Address
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Address Line | 107 W 20TH ST
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City | MOUNT PLEASANT
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State | TX
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Zip | 75455-2323
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Country | US
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Telephone | 903-575-7856
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Fax | 903-572-3407
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Provider Business Mailing Address
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Address Line | 107 W 20TH ST
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City | MOUNT PLEASANT
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State | TX
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Zip | 75455-2323
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Country | US
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Telephone | 903-575-7856
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Fax | 903-572-3407
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Authorized Official
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Title or Position | NURSE PRACTITIONER
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Name | SUSAN BRANHAM
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Credential | ANP-BC, PMHNP-BC
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Telephone | 903-575-7856
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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