Charisse Alene Braxton, FNP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

RN143102 Issued in GA

Practice address

3615 Marietta Hwy
Dallas, GA 30157-9472

Phone

(770) 505-9592

Fax

(770) 505-7480

NPI assigned

Jun 16, 2006

Sex

Female

Sole proprietor

No

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Piedmont Cardiology of Atlanta, LLC

  • Cardiovascular Disease Physician
  • Atlanta, GA
  • NPI 1275729691
  NPD (past)
• Take Care Health Georgia, P.C.

  • Family Nurse Practitioner
  • Kennesaw, GA
  • NPI 1043409964

  Family

  NPD (past)
• Rediclinic LLC

  • Clinic/Center
  • Owasso, OK
  • NPI 1528107141
  NPD (past)

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

• Charisse Alene Gathers Former name

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Jul 24, 2008.

{
    "created_epoch": "1150416000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1216857600000",
    "number": "1285678482",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9 GREENWAY PLZ",
            "address_2": "SUITE 2950",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "770460905",
            "telephone_number": "866-607-7334",
            "fax_number": "713-358-4849"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3615 MARIETTA HWY",
            "city": "DALLAS",
            "state": "GA",
            "postal_code": "301579472",
            "telephone_number": "770-505-9592",
            "fax_number": "770-505-7480"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRAXTON",
        "first_name": "CHARISSE",
        "middle_name": "ALENE",
        "name_prefix": "Mrs.",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-06-16",
        "last_updated": "2008-07-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "CA",
            "license": "RN143102",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "GA",
            "license": "RN143102",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "CHARISSE",
            "last_name": "GATHERS",
            "middle_name": "ALENE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Boundless Love Psychotherapy, LLC
• Seth Bowers
• Anna Cochran Braddy, PHARMD
• Brand New Start Treatment Center- Paulding LLC
• Chantease Braxton
• Gabrielle Brendahl
• Melissa Brice, IBCLC, ALC
• Bridave Healthcare LLC
• Amanda Bright, OT
• Brikada Cares LLC

• All providers in Dallas, GA
• Family Nurse Practitioner in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 24, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.