Provider Demographics
NPI:1740344415
Name:BRANHAM, STEVEN WAYNE (RN, ACNP)
Entity type:Individual
Prefix:
First Name:STEVEN
Middle Name:WAYNE
Last Name:BRANHAM
Suffix:
Gender:M
Credentials:RN, ACNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6501 FANNIN ST STE NC114
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-2703
Mailing Address - Country:US
Mailing Address - Phone:713-798-7356
Mailing Address - Fax:
Practice Address - Street 1:1353 N TRAVIS ST
Practice Address - Street 2:
Practice Address - City:LIBERTY
Practice Address - State:TX
Practice Address - Zip Code:77575-3549
Practice Address - Country:US
Practice Address - Phone:936-336-7316
Practice Address - Fax:936-336-5947
Is Sole Proprietor?:No
Enumeration Date:2006-12-20
Last Update Date:2022-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX587893363L00000X, 363LA2100X, 363LF0000X
TXAP107844363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXS81260Medicare UPIN