Provider Demographics
NPI:1639314693
Name:BRANSON, DENISE RENEE (PA-C)
Entity Type:Individual
Prefix:
First Name:DENISE
Middle Name:RENEE
Last Name:BRANSON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 S SARA RD STE 200
Mailing Address - Street 2:
Mailing Address - City:MUSTANG
Mailing Address - State:OK
Mailing Address - Zip Code:73064-4308
Mailing Address - Country:US
Mailing Address - Phone:405-578-3250
Mailing Address - Fax:405-578-3299
Practice Address - Street 1:201 S SARA RD STE 200
Practice Address - Street 2:
Practice Address - City:MUSTANG
Practice Address - State:OK
Practice Address - Zip Code:73064
Practice Address - Country:US
Practice Address - Phone:405-578-3250
Practice Address - Fax:405-578-3299
Is Sole Proprietor?:No
Enumeration Date:2008-12-04
Last Update Date:2020-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2433363A00000X
TXPA04415363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant