Provider Demographics
NPI:1346510625
Name:BRANAM, ALLISON JILL (PA-C)
Entity Type:Individual
Prefix:
First Name:ALLISON
Middle Name:JILL
Last Name:BRANAM
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:550 SUNSET TRL
Mailing Address - Street 2:PO BOX 30
Mailing Address - City:JELLICO
Mailing Address - State:TN
Mailing Address - Zip Code:37762-2343
Mailing Address - Country:US
Mailing Address - Phone:423-784-5771
Mailing Address - Fax:423-784-6185
Practice Address - Street 1:550 SUNSET TRL
Practice Address - Street 2:
Practice Address - City:JELLICO
Practice Address - State:TN
Practice Address - Zip Code:37762-2343
Practice Address - Country:US
Practice Address - Phone:423-784-5771
Practice Address - Fax:423-784-6185
Is Sole Proprietor?:No
Enumeration Date:2012-01-04
Last Update Date:2017-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2038363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant