Basic Information
| Provider Information | |||||||||
| NPI: | 1790160943 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BRANTLEY | ||||||||
| FirstName: | SHANNA | ||||||||
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| Credential: | FNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 511 STATE HIGHWAY 123 N | ||||||||
| Address2: | |||||||||
| City: | STOCKDALE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 781606019 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2106831234 | ||||||||
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| Practice Location | |||||||||
| Address1: | 601 PERSON STREET | ||||||||
| Address2: | |||||||||
| City: | STOCKDALE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 78160 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8309963701 | ||||||||
| FaxNumber: | 8309963749 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/29/2015 | ||||||||
| LastUpdateDate: | 07/29/2015 | ||||||||
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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 | 363LF0000X | APN128635 | TX | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.