MEDICARE: SUSAN L BRANHAM RN, ANP-BC, PMHNP-BC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LA2200X	Adult Health Nurse Practitioner	AP117248	TX
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	AP117248	TX

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	NP 0439	OTHER	TX	MEDICARE PTAN

General Provider Information

NPI Number	:	1154574747
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSAN L BRANHAM RN, ANP-BC, PMHNP-BC

Provider Business Mailing Address
First Line	:	107 W 20TH ST
Second Line	:
City	:	MOUNT PLEASANT
State	:	TX
Zip	:	75455-2323
Country	:	US
Telephone Number	:	903-575-7856
Fax Number	:	903-946-5258

Provider Business Practice Location Address
First Line	:	107 W 20TH ST
Second Line	:
City	:	MOUNT PLEASANT
State	:	TX
Zip	:	75455-2323
Country	:	US
Telephone Number	:	903-575-7856
Fax Number	:	903-572-3407

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/28/2008
Last Update Date	:	06/20/2025

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