MEDICARE: JENIFER L BRANSON PA

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	363A00000X	Physician Assistant	PA02649	TX

General Provider Information

NPI Number	:	1235312299
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENIFER L BRANSON PA

Provider Business Mailing Address
First Line	:	3591 MCKINNEY ST
Second Line	:	SUITE 100
City	:	MELISSA
State	:	TX
Zip	:	75454-9571
Country	:	US
Telephone Number	:	972-837-1075
Fax Number	:	972-837-4120

Provider Business Practice Location Address
First Line	:	3591 MCKINNEY ST
Second Line	:	SUITE 100
City	:	MELISSA
State	:	TX
Zip	:	75454-9571
Country	:	US
Telephone Number	:	972-837-1075
Fax Number	:	972-837-4120

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

Provider Enumeration Date	:	12/13/2007
Last Update Date	:	05/22/2012

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