Provider Demographics
NPI:1043436546
Name:BRANNON, JENNIFER ANN (MD)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:ANN
Last Name:BRANNON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1010 N. KANSAS
Mailing Address - Street 2:SUITE #3049
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67214-3199
Mailing Address - Country:US
Mailing Address - Phone:316-293-2631
Mailing Address - Fax:316-293-2689
Practice Address - Street 1:1010 N. KANSAS
Practice Address - Street 2:SUITE #3049
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67214-3199
Practice Address - Country:US
Practice Address - Phone:316-293-2631
Practice Address - Fax:316-293-2689
Is Sole Proprietor?:No
Enumeration Date:2007-04-17
Last Update Date:2008-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0431684208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics