Basic Information
| Provider Information | |||||||||
| NPI: | 1346510625 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BRANAM | ||||||||
| FirstName: | ALLISON | ||||||||
| MiddleName: | JILL | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 550 SUNSET TRL | ||||||||
| Address2: | PO BOX 30 | ||||||||
| City: | JELLICO | ||||||||
| State: | TN | ||||||||
| PostalCode: | 377622343 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4237845771 | ||||||||
| FaxNumber: | 4237846185 | ||||||||
| Practice Location | |||||||||
| Address1: | 550 SUNSET TRL | ||||||||
| Address2: | |||||||||
| City: | JELLICO | ||||||||
| State: | TN | ||||||||
| PostalCode: | 377622343 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4237845771 | ||||||||
| FaxNumber: | 4237846185 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/04/2012 | ||||||||
| LastUpdateDate: | 03/08/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | 2038 | TN | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.