Individual
DR. FAYE ALICIA BRANUM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
2865 CHURN CREEK RD, REDDING, CA 96002-1117
(530) 226-7419
(530) 224-9433
Mailing address
2165 LARKSPUR LN, REDDING, CA 96002-0600
(618) 303-6878
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
2012025737
MO
363A00000X
Physician Assistant
Primary
52974
CA
363A00000X
Physician Assistant
PA52974
CA
364SP0808X
Psychiatric/Mental Health Clinical Nurse Specialist
52974
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
490903974
—
IL
01
—
PA52974
CALIFORNIA PA LICENSE
CA
Enumeration date
08/29/2012
Last updated
09/17/2024
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