MEDICARE: MRS. PRISCILLA MARIE BRANNON MSN, APRN, FNP-C

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	363LF0000X	Family Nurse Practitioner	1059802	TX

General Provider Information

NPI Number	:	1922766856
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. PRISCILLA MARIE BRANNON MSN, APRN, FNP-C

Provider Business Mailing Address
First Line	:	312 E RENFRO ST STE 105
Second Line	:
City	:	BURLESON
State	:	TX
Zip	:	76028-3948
Country	:	US
Telephone Number	:	817-968-5756
Fax Number	:	817-989-2716

Provider Business Practice Location Address
First Line	:	312 E RENFRO ST STE 105
Second Line	:
City	:	BURLESON
State	:	TX
Zip	:	76028-3948
Country	:	US
Telephone Number	:	817-968-5756
Fax Number	:	817-989-2716

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

Provider Enumeration Date	:	12/08/2021
Last Update Date	:	05/08/2024

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