Provider Demographics
NPI:1205036746
Name:BURCHELL, BRANDY M (FNP)
Entity Type:Individual
Prefix:
First Name:BRANDY
Middle Name:M
Last Name:BURCHELL
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2550 WINDY HILL RD SE STE 215
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30067-8654
Mailing Address - Country:US
Mailing Address - Phone:770-850-8464
Mailing Address - Fax:770-850-9727
Practice Address - Street 1:2805 W GOVERNOR JOHN SEVIER HWY
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37920-5552
Practice Address - Country:US
Practice Address - Phone:865-951-0539
Practice Address - Fax:865-249-6746
Is Sole Proprietor?:No
Enumeration Date:2007-07-23
Last Update Date:2014-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN12829363LF0000X
TNAPN0000012829363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ003601Medicaid
TN10350I5562Medicare PIN