Provider Demographics
NPI:1700065570
Name:BRANTON, DONNA JILL (NP)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:JILL
Last Name:BRANTON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3370
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:LA
Mailing Address - Zip Code:70434-3370
Mailing Address - Country:US
Mailing Address - Phone:985-400-5988
Mailing Address - Fax:985-256-5687
Practice Address - Street 1:1970 N HIGHWAY 190
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:LA
Practice Address - Zip Code:70433-5364
Practice Address - Country:US
Practice Address - Phone:985-400-5988
Practice Address - Fax:985-867-3644
Is Sole Proprietor?:No
Enumeration Date:2007-10-30
Last Update Date:2021-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP04581363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1590185Medicaid
LA3B682DM93Medicare PIN