Provider Demographics
NPI:1285678482
Name:BRAXTON, CHARISSE ALENE (FNP)
Entity Type:Individual
Prefix:MRS
First Name:CHARISSE
Middle Name:ALENE
Last Name:BRAXTON
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:CHARISSE
Other - Middle Name:ALENE
Other - Last Name:GATHERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9 GREENWAY PLZ
Mailing Address - Street 2:SUITE 2950
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77046-0905
Mailing Address - Country:US
Mailing Address - Phone:866-607-7334
Mailing Address - Fax:713-358-4849
Practice Address - Street 1:3615 MARIETTA HWY
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:GA
Practice Address - Zip Code:30157-9472
Practice Address - Country:US
Practice Address - Phone:770-505-9592
Practice Address - Fax:770-505-7480
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2008-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARN143102163W00000X
GARN143102363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse