Provider Demographics
NPI:1255711909
Name:BRANSON, DARIN R (APRN FNP-C)
Entity type:Individual
Prefix:MR
First Name:DARIN
Middle Name:R
Last Name:BRANSON
Suffix:
Gender:M
Credentials: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 1:4275 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:GRAY
Mailing Address - State:LA
Mailing Address - Zip Code:70359-6410
Mailing Address - Country:US
Mailing Address - Phone:985-360-3781
Mailing Address - Fax:985-360-3782
Practice Address - Street 1:4275 W MAIN ST
Practice Address - Street 2:
Practice Address - City:GRAY
Practice Address - State:LA
Practice Address - Zip Code:70359-6410
Practice Address - Country:US
Practice Address - Phone:985-360-3781
Practice Address - Fax:985-360-3782
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-08
Last Update Date:2023-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP08303363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA681616500149-005Medicaid