Provider Demographics
NPI:1235312299
Name:BRANSON, JENIFER L (PA)
Entity Type:Individual
Prefix:
First Name:JENIFER
Middle Name:L
Last Name:BRANSON
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3591 MCKINNEY ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:MELISSA
Mailing Address - State:TX
Mailing Address - Zip Code:75454-9571
Mailing Address - Country:US
Mailing Address - Phone:972-837-1075
Mailing Address - Fax:972-837-4120
Practice Address - Street 1:3591 MCKINNEY ST
Practice Address - Street 2:SUITE 100
Practice Address - City:MELISSA
Practice Address - State:TX
Practice Address - Zip Code:75454-9571
Practice Address - Country:US
Practice Address - Phone:972-837-1075
Practice Address - Fax:972-837-4120
Is Sole Proprietor?:No
Enumeration Date:2007-12-13
Last Update Date:2012-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA02649363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8K3162Medicare PIN