Provider Demographics
NPI:1477873487
Name:BRANYON, CHARLOTTE ANNE GROVER (FNP)
Entity type:Individual
Prefix:MRS
First Name:CHARLOTTE
Middle Name:ANNE GROVER
Last Name:BRANYON
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 1:7611 HIGHWAY 76 STE C
Mailing Address - Street 2:
Mailing Address - City:PENDLETON
Mailing Address - State:SC
Mailing Address - Zip Code:29670-9162
Mailing Address - Country:US
Mailing Address - Phone:864-546-5570
Mailing Address - Fax:864-546-5571
Practice Address - Street 1:7611 HIGHWAY 76 STE C
Practice Address - Street 2:
Practice Address - City:PENDLETON
Practice Address - State:SC
Practice Address - Zip Code:29670-9162
Practice Address - Country:US
Practice Address - Phone:864-546-5570
Practice Address - Fax:864-546-5571
Is Sole Proprietor?:No
Enumeration Date:2010-06-02
Last Update Date:2013-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCF 4237363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCAA58930381OtherPTAN