Provider Demographics
NPI:1922766856
Name:BRANNON, PRISCILLA MARIE (MSN, APRN, FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:PRISCILLA
Middle Name:MARIE
Last Name:BRANNON
Suffix:
Gender:F
Credentials:MSN, APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 TEMPLETON DR
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76107-2252
Mailing Address - Country:US
Mailing Address - Phone:682-521-0000
Mailing Address - Fax:
Practice Address - Street 1:312 E RENFRO ST STE 105
Practice Address - Street 2:
Practice Address - City:BURLESON
Practice Address - State:TX
Practice Address - Zip Code:76028-3948
Practice Address - Country:US
Practice Address - Phone:817-968-5756
Practice Address - Fax:817-989-2716
Is Sole Proprietor?:No
Enumeration Date:2021-12-08
Last Update Date:2022-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1059802363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily