Provider Demographics
NPI:1417562224
Name:BRANSTETTER, COREY MICHELLE (APRN)
Entity type:Individual
Prefix:
First Name:COREY
Middle Name:MICHELLE
Last Name:BRANSTETTER
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 1:15 EQUITY CT
Mailing Address - Street 2:
Mailing Address - City:BATESVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72501-6343
Mailing Address - Country:US
Mailing Address - Phone:870-805-9379
Mailing Address - Fax:
Practice Address - Street 1:407 VIRGINIA DR
Practice Address - Street 2:
Practice Address - City:BATESVILLE
Practice Address - State:AR
Practice Address - Zip Code:72501-7329
Practice Address - Country:US
Practice Address - Phone:870-793-4200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-09
Last Update Date:2020-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR212978363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily