Provider Demographics
NPI:1104367168
Name:BRANSON, TERRIE (AGACNP)
Entity Type:Individual
Prefix:
First Name:TERRIE
Middle Name:
Last Name:BRANSON
Suffix:
Gender:F
Credentials:AGACNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:614 S EDMONDS LN STE 101
Mailing Address - Street 2:
Mailing Address - City:LEWISVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75067-3624
Mailing Address - Country:US
Mailing Address - Phone:972-434-1988
Mailing Address - Fax:
Practice Address - Street 1:614 S EDMONDS LN STE 101
Practice Address - Street 2:
Practice Address - City:LEWISVILLE
Practice Address - State:TX
Practice Address - Zip Code:75067-3624
Practice Address - Country:US
Practice Address - Phone:972-434-1988
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-10
Last Update Date:2021-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP133098363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care