Provider Demographics
NPI:1447909411
Name:BRAWNER, LEANN
Entity type:Individual
Prefix:
First Name:LEANN
Middle Name:
Last Name:BRAWNER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 COUNTY ROAD 717
Mailing Address - Street 2:
Mailing Address - City:WYNNE
Mailing Address - State:AR
Mailing Address - Zip Code:72396-8004
Mailing Address - Country:US
Mailing Address - Phone:870-919-3192
Mailing Address - Fax:
Practice Address - Street 1:33 COUNTY ROAD 717
Practice Address - Street 2:
Practice Address - City:WYNNE
Practice Address - State:AR
Practice Address - Zip Code:72396-8004
Practice Address - Country:US
Practice Address - Phone:870-919-3192
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-18
Last Update Date:2022-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR218075363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty