Provider Demographics
NPI:1962122770
Name:BRANTLEY, REBECCA ANN (MD)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:ANN
Last Name:BRANTLEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:88 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:MT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29464-2874
Mailing Address - Country:US
Mailing Address - Phone:504-568-4750
Mailing Address - Fax:504-568-2202
Practice Address - Street 1:2021 PERDIDO ST
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70112-1352
Practice Address - Country:US
Practice Address - Phone:504-568-4750
Practice Address - Fax:504-568-2202
Is Sole Proprietor?:No
Enumeration Date:2022-08-31
Last Update Date:2023-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program