Provider Demographics
NPI:1952376923
Name:BRANCHE, KRISTEN A (WHNP)
Entity Type:Individual
Prefix:MS
First Name:KRISTEN
Middle Name:A
Last Name:BRANCHE
Suffix:
Gender:F
Credentials:WHNP
Other - Prefix:
Other - First Name:KRISTEN
Other - Middle Name:A
Other - Last Name:MINNICK-SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:2155 E CONFERENCE DR STE 115
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85284-2604
Mailing Address - Country:US
Mailing Address - Phone:480-831-2445
Mailing Address - Fax:480-897-1283
Practice Address - Street 1:2155 E CONFERENCE DR STE 115
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85284-2604
Practice Address - Country:US
Practice Address - Phone:480-831-2445
Practice Address - Fax:480-897-1283
Is Sole Proprietor?:No
Enumeration Date:2006-02-22
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN254159L363L00000X
AZAP2657363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ549485Medicaid
AZMM0938831OtherDEA CERTIFICATE
S76649Medicare UPIN