Provider Demographics
NPI:1902598246
Name:WOOTSON, BREANNA (CRNP)
Entity Type:Individual
Prefix:
First Name:BREANNA
Middle Name:
Last Name:WOOTSON
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:157 SILVER STRAND TRL
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35806-4710
Mailing Address - Country:US
Mailing Address - Phone:256-468-6045
Mailing Address - Fax:
Practice Address - Street 1:4258 HIGHWAY 231 STE 5
Practice Address - Street 2:
Practice Address - City:LACEYS SPRING
Practice Address - State:AL
Practice Address - Zip Code:35754-6444
Practice Address - Country:US
Practice Address - Phone:256-498-6500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-24
Last Update Date:2023-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-160877363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily