Provider Demographics
NPI:1487167979
Name:BRANHAM, CAITLIN JO (APRN, PMHNP-BC)
Entity type:Individual
Prefix:
First Name:CAITLIN
Middle Name:JO
Last Name:BRANHAM
Suffix:
Gender:F
Credentials:APRN, PMHNP-BC
Other - Prefix:
Other - First Name:CAITLIN
Other - Middle Name:JO
Other - Last Name:JONES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 368
Mailing Address - Street 2:
Mailing Address - City:WINNSBORO
Mailing Address - State:TX
Mailing Address - Zip Code:75494-0368
Mailing Address - Country:US
Mailing Address - Phone:903-575-8245
Mailing Address - Fax:903-572-3407
Practice Address - Street 1:107 W 20TH ST
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:TX
Practice Address - Zip Code:75455
Practice Address - Country:US
Practice Address - Phone:903-575-8245
Practice Address - Fax:903-575-8245
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-07
Last Update Date:2019-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX790462163W00000X
COC-APN.0000886-C-NP363LP0808X
TXAP137425363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse