Provider Demographics
NPI:1497399463
Name:BRANNON, DELORIS (APRN, FNP)
Entity Type:Individual
Prefix:
First Name:DELORIS
Middle Name:
Last Name:BRANNON
Suffix:
Gender:F
Credentials:APRN, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5138 LAKESIDE DR
Mailing Address - Street 2:
Mailing Address - City:PORT ARTHUR
Mailing Address - State:TX
Mailing Address - Zip Code:77642-1144
Mailing Address - Country:US
Mailing Address - Phone:409-217-0655
Mailing Address - Fax:
Practice Address - Street 1:5138 LAKESIDE DR
Practice Address - Street 2:
Practice Address - City:PORT ARTHUR
Practice Address - State:TX
Practice Address - Zip Code:77642-1144
Practice Address - Country:US
Practice Address - Phone:409-217-0655
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-03
Last Update Date:2019-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP141493363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily