Basic Information
| Provider Information | |||||||||
| NPI: | 1659513802 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BRANSON | ||||||||
| FirstName: | KAREN | ||||||||
| MiddleName: | JEANETTE | ||||||||
| NamePrefix: | |||||||||
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| Credential: | |||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastNameType: | |||||||||
| Mailing Information | |||||||||
| Address1: | 619 N MAIN ST | ||||||||
| Address2: | |||||||||
| City: | MUSKOGEE | ||||||||
| State: | OK | ||||||||
| PostalCode: | 744014431 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9186828407 | ||||||||
| FaxNumber: | 9186870976 | ||||||||
| Practice Location | |||||||||
| Address1: | 619 N MAIN ST | ||||||||
| Address2: | |||||||||
| City: | MUSKOGEE | ||||||||
| State: | OK | ||||||||
| PostalCode: | 744014431 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9186828407 | ||||||||
| FaxNumber: | 9186870976 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/02/2009 | ||||||||
| LastUpdateDate: | 04/02/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 172V00000X | Y | Other Service Providers | Community Health Worker |
No ID Information.