MEDICARE: SUSAN BRANHAM

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
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner

General Provider Information

NPI Number	:	1871117580
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUSAN BRANHAM

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	:	903-572-3407

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	:	NURSE PRACTITIONER
Name	:	SUSAN BRANHAM
Credential	:	ANP-BC, PMHNP-BC
Telephone Number	:	903-575-7856

Provider Enumeration Date	:	05/29/2020
Last Update Date	:	05/29/2020

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Directions to “SUSAN BRANHAM ” Practice Location

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