Provider Demographics
NPI:1356407720
Name:BRANT, MARY M (PHD, MSN, APRN)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:M
Last Name:BRANT
Suffix:
Gender:F
Credentials:PHD, MSN, APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:39055 E STATE HIGHWAY 146
Mailing Address - Street 2:
Mailing Address - City:GILMAN CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64642-7215
Mailing Address - Country:US
Mailing Address - Phone:816-351-6997
Mailing Address - Fax:660-876-5520
Practice Address - Street 1:1628 OKLAHOMA AVE
Practice Address - Street 2:
Practice Address - City:TRENTON
Practice Address - State:MO
Practice Address - Zip Code:64683-2565
Practice Address - Country:US
Practice Address - Phone:660-359-4600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-29
Last Update Date:2024-10-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO2021028550363LP0808X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO496300807Medicaid
MO496300807Medicaid