Provider Demographics
NPI:1164171831
Name:MEADOWS, BREANNA JANE (NP)
Entity Type:Individual
Prefix:
First Name:BREANNA
Middle Name:JANE
Last Name:MEADOWS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:BREANNA
Other - Middle Name:
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:225 N WILLOW AVE STE 3
Mailing Address - Street 2:
Mailing Address - City:COOKEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38501-2453
Mailing Address - Country:US
Mailing Address - Phone:931-528-8899
Mailing Address - Fax:866-449-4618
Practice Address - Street 1:225 N WILLOW AVE STE 3
Practice Address - Street 2:
Practice Address - City:COOKEVILLE
Practice Address - State:TN
Practice Address - Zip Code:38501-2453
Practice Address - Country:US
Practice Address - Phone:931-528-8899
Practice Address - Fax:866-449-4618
Is Sole Proprietor?:No
Enumeration Date:2022-03-21
Last Update Date:2023-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN31380363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily