Provider Demographics
NPI:1609588797
Name:BRANTLEY, NATALIE CARROLL BEASLEY
Entity Type:Individual
Prefix:MRS
First Name:NATALIE
Middle Name:CARROLL BEASLEY
Last Name:BRANTLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:411 NEW HOPE CHURCH RD
Mailing Address - Street 2:
Mailing Address - City:TURKEY
Mailing Address - State:NC
Mailing Address - Zip Code:28393-9193
Mailing Address - Country:US
Mailing Address - Phone:910-271-0892
Mailing Address - Fax:
Practice Address - Street 1:2601 LAKE DR STE 301
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27607-6689
Practice Address - Country:US
Practice Address - Phone:919-782-5911
Practice Address - Fax:919-861-6400
Is Sole Proprietor?:No
Enumeration Date:2022-12-20
Last Update Date:2022-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5017374207VE0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VE0102XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyReproductive Endocrinology