Provider Demographics
NPI:1891574851
Name:BRANSTON, ALLYSON JAIME (FNP-C)
Entity Type:Individual
Prefix:
First Name:ALLYSON
Middle Name:JAIME
Last Name:BRANSTON
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4017 N 40TH ST APT 1
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85018-5243
Mailing Address - Country:US
Mailing Address - Phone:480-353-0085
Mailing Address - Fax:
Practice Address - Street 1:4808 N 24TH ST STE 125
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85016-9120
Practice Address - Country:US
Practice Address - Phone:480-353-0085
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-27
Last Update Date:2024-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ296021363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily