Provider Demographics
NPI:1851565261
Name:BRANNON, RACHEL DIANE (NP)
Entity Type:Individual
Prefix:MRS
First Name:RACHEL
Middle Name:DIANE
Last Name:BRANNON
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 1:6438 WILMINGTON PIKE STE 300
Mailing Address - Street 2:
Mailing Address - City:CENTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45459-7021
Mailing Address - Country:US
Mailing Address - Phone:937-848-4850
Mailing Address - Fax:937-848-4858
Practice Address - Street 1:6438 WILMINGTON PIKE
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45459-7022
Practice Address - Country:US
Practice Address - Phone:937-848-4850
Practice Address - Fax:937-848-4858
Is Sole Proprietor?:No
Enumeration Date:2008-04-16
Last Update Date:2020-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA10050NP363L00000X, 363LW0102X
OHRN 315363363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHCOA10050NPOtherOH MEDICAL LICENSE
OHCOA10050NPOtherOH MEDICAL LICENSE