Provider Demographics
NPI:1154574747
Name:BRANHAM, SUSAN L (RN, ANP-BC, PMHNP-BC)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:L
Last Name:BRANHAM
Suffix:
Gender:F
Credentials:RN, ANP-BC, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 W 20TH ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:TX
Mailing Address - Zip Code:75455-2323
Mailing Address - Country:US
Mailing Address - Phone:903-575-7856
Mailing Address - Fax:903-946-5258
Practice Address - Street 1:107 W 20TH ST
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:TX
Practice Address - Zip Code:75455-2323
Practice Address - Country:US
Practice Address - Phone:903-575-7856
Practice Address - Fax:903-572-3407
Is Sole Proprietor?:No
Enumeration Date:2008-10-28
Last Update Date:2020-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX638747363LA2200X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXNP 0439OtherMEDICARE PTAN