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Individual

MS. MARSHA M. BRACKEEN

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
P.A.-C.

Contact information

Practice address
400 SOLDIER CREEK DR, ROSEBUD, SD 57570-8502
(605) 747-0441
Mailing address
PO BOX 43, ROSEBUD, SD 57570-0043

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA 591
TN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
4009459
BLUE CROSS
TN
01
970015753
RAILROAD MEDICARE
TN
Enumeration date
05/24/2006
Last updated
03/17/2018
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