Provider Demographics
NPI:1417534330
Name:BRANNON, AMBER (CRNP)
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:
Last Name:BRANNON
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1118 ROSS CLARK CIR STE 303
Mailing Address - Street 2:
Mailing Address - City:DOTHAN
Mailing Address - State:AL
Mailing Address - Zip Code:36301-3034
Mailing Address - Country:US
Mailing Address - Phone:334-794-1148
Mailing Address - Fax:
Practice Address - Street 1:1118 ROSS CLARK CIR STE 100
Practice Address - Street 2:
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36301-3023
Practice Address - Country:US
Practice Address - Phone:334-794-1148
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-26
Last Update Date:2023-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-143459163WE0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WE0003XNursing Service ProvidersRegistered NurseEmergency