Provider Demographics
NPI:1801837489
Name:BRANYON, STACEY G (NP)
Entity Type:Individual
Prefix:
First Name:STACEY
Middle Name:G
Last Name:BRANYON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 S SHIRLEY AVE
Mailing Address - Street 2:
Mailing Address - City:HONEA PATH
Mailing Address - State:SC
Mailing Address - Zip Code:29654-1503
Mailing Address - Country:US
Mailing Address - Phone:864-512-7879
Mailing Address - Fax:864-512-7037
Practice Address - Street 1:21 S SHIRLEY AVE
Practice Address - Street 2:
Practice Address - City:HONEA PATH
Practice Address - State:SC
Practice Address - Zip Code:29654-1503
Practice Address - Country:US
Practice Address - Phone:864-369-0552
Practice Address - Fax:864-369-1826
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2022-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1125363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCN90647Medicaid
SC6608Medicare PIN
P819156608Medicare ID - Type Unspecified
SCN90647Medicaid