Provider Demographics
NPI:1942601497
Name:BRANCH, ADAM (NP-C)
Entity Type:Individual
Prefix:MR
First Name:ADAM
Middle Name:
Last Name:BRANCH
Suffix:
Gender:M
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:575 HILL COUNTRY DR
Mailing Address - Street 2:
Mailing Address - City:KERRVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78028-6024
Mailing Address - Country:US
Mailing Address - Phone:830-258-7762
Mailing Address - Fax:830-258-7118
Practice Address - Street 1:575 HILL COUNTRY DR STE 101
Practice Address - Street 2:
Practice Address - City:KERRVILLE
Practice Address - State:TX
Practice Address - Zip Code:78028
Practice Address - Country:US
Practice Address - Phone:830-258-7762
Practice Address - Fax:830-258-7118
Is Sole Proprietor?:No
Enumeration Date:2014-09-15
Last Update Date:2018-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN209150363L00000X
TXAP130247363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL168093Medicaid
GA003154314Medicaid
AL168093Medicaid