Provider Demographics
NPI:1376052860
Name:BRANTLEY, MARY HAZEL (MSN, RN, FNP-C)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:HAZEL
Last Name:BRANTLEY
Suffix:
Gender:F
Credentials:MSN, RN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
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Mailing Address - Street 1:4301 COLLEGE DR RM 400
Mailing Address - Street 2:
Mailing Address - City:VERNON
Mailing Address - State:TX
Mailing Address - Zip Code:76384-3166
Mailing Address - Country:US
Mailing Address - Phone:940-553-2802
Mailing Address - Fax:940-553-2893
Practice Address - Street 1:4301 COLLEGE DR RM 400
Practice Address - Street 2:
Practice Address - City:VERNON
Practice Address - State:TX
Practice Address - Zip Code:76384-3166
Practice Address - Country:US
Practice Address - Phone:940-553-2802
Practice Address - Fax:940-553-2893
Is Sole Proprietor?:No
Enumeration Date:2017-09-27
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP135219363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily