Provider Demographics
NPI:1972027324
Name:BRANNAN, HALEY BROOKE (RDN, LD)
Entity Type:Individual
Prefix:MRS
First Name:HALEY
Middle Name:BROOKE
Last Name:BRANNAN
Suffix:
Gender:F
Credentials:RDN, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1532 W 32ND ST STE 202
Mailing Address - Street 2:
Mailing Address - City:JOPLIN
Mailing Address - State:MO
Mailing Address - Zip Code:64804-1627
Mailing Address - Country:US
Mailing Address - Phone:417-347-5700
Mailing Address - Fax:
Practice Address - Street 1:1532 W 32ND ST STE 202
Practice Address - Street 2:
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64804-1627
Practice Address - Country:US
Practice Address - Phone:417-347-5700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-27
Last Update Date:2017-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2017025883133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered