Provider Demographics
NPI:1376175273
Name:BRANCH, KILEY RENNAE (APRN, AGACNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:KILEY
Middle Name:RENNAE
Last Name:BRANCH
Suffix:
Gender:F
Credentials:APRN, AGACNP-BC
Other - Prefix:MISS
Other - First Name:KILEY
Other - Middle Name:RENNAE
Other - Last Name:GRAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:35 COUNTRY VILLAGE CIR
Mailing Address - Street 2:
Mailing Address - City:CABOT
Mailing Address - State:AR
Mailing Address - Zip Code:72023-8669
Mailing Address - Country:US
Mailing Address - Phone:501-764-8816
Mailing Address - Fax:
Practice Address - Street 1:4301 W MARKHAM ST
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-7101
Practice Address - Country:US
Practice Address - Phone:501-686-8000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-08
Last Update Date:2020-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR123890363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care