Provider Demographics
NPI:1871117580
Name:SUSAN BRANHAM
Entity type:Organization
Organization Name:SUSAN BRANHAM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BRANHAM
Authorized Official - Suffix:
Authorized Official - Credentials:ANP-BC, PMHNP-BC
Authorized Official - Phone:903-575-7856
Mailing Address - Street 1:107 W 20TH ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:TX
Mailing Address - Zip Code:75455-2323
Mailing Address - Country:US
Mailing Address - Phone:903-575-7856
Mailing Address - Fax:903-572-3407
Practice Address - Street 1:107 W 20TH ST
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:TX
Practice Address - Zip Code:75455-2323
Practice Address - Country:US
Practice Address - Phone:903-575-7856
Practice Address - Fax:903-572-3407
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-29
Last Update Date:2020-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Multi-Specialty