Provider Demographics
NPI:1376806760
Name:BRANNON, GRETCHEN E (FNP- BC)
Entity Type:Individual
Prefix:MS
First Name:GRETCHEN
Middle Name:E
Last Name:BRANNON
Suffix:
Gender:F
Credentials:FNP- BC
Other - Prefix:
Other - First Name:GRETCHEN
Other - Middle Name:E
Other - Last Name:REINHARDT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP-BC
Mailing Address - Street 1:50 S SCHOOL AVE APT 2
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72701-5906
Mailing Address - Country:US
Mailing Address - Phone:479-856-1237
Mailing Address - Fax:
Practice Address - Street 1:114 HARRISON AVE.
Practice Address - Street 2:LOWELL PHARMACY BLDS
Practice Address - City:LOWELL
Practice Address - State:AR
Practice Address - Zip Code:72745
Practice Address - Country:US
Practice Address - Phone:479-770-4343
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-20
Last Update Date:2016-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA03694363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily