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General NPI Number Information
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NPI Number | 1962215293
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Entity Type | Individual
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Provider Name | MIKEISHA BRANNOCK RDN
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Gender | Female
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Dates
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Enumeration Date | 01/30/2025
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Last Update Date | 01/30/2025
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Provider Practice Location Address
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Address Line | 20 MEDICAL CAMPUS DR NW STE 206
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City | SUPPLY
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State | NC
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Zip | 28462-4094
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Country | US
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Telephone | 910-239-3562
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Fax |
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Provider Business Mailing Address
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Address Line | 2517 DELANEY AVE
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City | WILMINGTON
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State | NC
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Zip | 28403-6003
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Country | US
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Telephone | 910-239-3562
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Fax | 877-889-2993
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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 | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number |
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License Number State |
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