Provider Demographics
NPI:1316928609
Name:BRANHAM, KATHERINE E (FNP)
Entity type:Individual
Prefix:MS
First Name:KATHERINE
Middle Name:E
Last Name:BRANHAM
Suffix:
Gender:F
Credentials:FNP
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 255
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:MO
Mailing Address - Zip Code:65010-0255
Mailing Address - Country:US
Mailing Address - Phone:573-657-7330
Mailing Address - Fax:573-657-1772
Practice Address - Street 1:504 E BROADWAY
Practice Address - Street 2:SUITE A
Practice Address - City:ASHLAND
Practice Address - State:MO
Practice Address - Zip Code:65010-9538
Practice Address - Country:US
Practice Address - Phone:573-657-7330
Practice Address - Fax:573-657-1772
Is Sole Proprietor?:No
Enumeration Date:2005-11-14
Last Update Date:2011-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO104711363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO507374205Medicaid
MO424895126Medicaid
MO000014728Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER
MO827384728Medicare ID - Type UnspecifiedMEDICARE IND. NUMBER
MO507374205Medicaid