Provider Demographics
NPI:1922428820
Name:BRANNAN, KORI (PA)
Entity Type:Individual
Prefix:
First Name:KORI
Middle Name:
Last Name:BRANNAN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 PROSPECT AVE
Mailing Address - Street 2:
Mailing Address - City:HOT SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:71901-4003
Mailing Address - Country:US
Mailing Address - Phone:501-622-3334
Mailing Address - Fax:
Practice Address - Street 1:120 ADCOCK RD STE C
Practice Address - Street 2:
Practice Address - City:HOT SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:71913-7958
Practice Address - Country:US
Practice Address - Phone:501-651-4488
Practice Address - Fax:501-651-4499
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-18
Last Update Date:2023-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR5772255A2300X
ARPA-1174363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer