Provider Demographics
NPI:1417224239
Name:BRANHAM, CRYSTAL L (APRN)
Entity type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:L
Last Name:BRANHAM
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:174 W CEDAR DR
Mailing Address - Street 2:
Mailing Address - City:PIKEVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:41501-2015
Mailing Address - Country:US
Mailing Address - Phone:606-794-5206
Mailing Address - Fax:606-754-5796
Practice Address - Street 1:174 W CEDAR DR
Practice Address - Street 2:
Practice Address - City:PIKEVILLE
Practice Address - State:KY
Practice Address - Zip Code:41501-2015
Practice Address - Country:US
Practice Address - Phone:606-794-5206
Practice Address - Fax:606-754-5796
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-22
Last Update Date:2024-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3007228363LP0808X, 363LF0000X
KS53-82469-061363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY2011013543OtherAMERICAN NURSES /FAMILY NURSE PRACTITIONER
KY3007228OtherKENTUCKY APRN LICENSURE
KY7100196230Medicaid
KY3007228OtherKENTUCKY APRN LICENSURE