Provider Demographics
NPI:1689805103
Name:BRANAMAN, KENNETH RICHARD
Entity Type:Individual
Prefix:MR
First Name:KENNETH
Middle Name:RICHARD
Last Name:BRANAMAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 PRAIRIE DR
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:WY
Mailing Address - Zip Code:82834-9340
Mailing Address - Country:US
Mailing Address - Phone:307-620-5063
Mailing Address - Fax:
Practice Address - Street 1:7 PRAIRIE DR
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:WY
Practice Address - Zip Code:82834-9340
Practice Address - Country:US
Practice Address - Phone:307-620-5063
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-31
Last Update Date:2009-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator