Provider Demographics
NPI:1124782339
Name:BRANSON, MARK (AGACNP)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:BRANSON
Suffix:
Gender:
Credentials:AGACNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3308 CAPETOWN DR
Mailing Address - Street 2:
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76208-7649
Mailing Address - Country:US
Mailing Address - Phone:940-727-9511
Mailing Address - Fax:
Practice Address - Street 1:3201 COLORADO BLVD STE 101
Practice Address - Street 2:
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76210-6929
Practice Address - Country:US
Practice Address - Phone:940-483-9898
Practice Address - Fax:833-606-0625
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-25
Last Update Date:2025-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1056311363LA2100X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care