Provider Demographics
NPI:1477393627
Name:BRANTINGHAM, MICHELLE L (ARNP, PMHNP-BC)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:L
Last Name:BRANTINGHAM
Suffix:
Gender:F
Credentials:ARNP, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3810 KERN WAY STE B
Mailing Address - Street 2:
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98902-7805
Mailing Address - Country:US
Mailing Address - Phone:509-969-2596
Mailing Address - Fax:509-204-9154
Practice Address - Street 1:3810 KERN WAY STE B
Practice Address - Street 2:
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98902-7805
Practice Address - Country:US
Practice Address - Phone:509-969-2596
Practice Address - Fax:509-204-9154
Is Sole Proprietor?:No
Enumeration Date:2024-05-27
Last Update Date:2024-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP61563418363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health