Doctor Name: | DEBORAH KAY BRANTLY |
NPI Number: | 1639198542 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | MS, CNS |
License Number: | R0034728 |
Business Practice Address: | 119 W Main St Hominy, OK - 740351031 |
Business Phone Number: | 9188854640 |
Business Fax Number: | 9188854644 |
Mailing Address: | 212 N Main St, FAIRFAX |
State: | OK |
Postal Code: | 74637 |
Phone Number: | 9186423100 |
Fax Number: | 9186425639 |
NPI Enumeration Date: | 07/19/2006 |
NPI Last Update Date: | 03/16/2016 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 364SP0808X |
License Number: | R0034728 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | OK |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Clinical Nurse Specialist |
Taxonomy Specialization: | Psych/Mental Health |
Taxonomy Definition: |