Provider Demographics
NPI:1205397809
Name:JOHNSON BRATCHER, RAVEN (DNP, APRN, FNP)
Entity Type:Individual
Prefix:
First Name:RAVEN
Middle Name:
Last Name:JOHNSON BRATCHER
Suffix:
Gender:F
Credentials:DNP, APRN, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10086 BLOOMSBURY AVE
Mailing Address - Street 2:
Mailing Address - City:CORDOVA
Mailing Address - State:TN
Mailing Address - Zip Code:38016-0303
Mailing Address - Country:US
Mailing Address - Phone:901-690-6555
Mailing Address - Fax:
Practice Address - Street 1:1785 NONCONNAH BLVD STE 120
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38132-2112
Practice Address - Country:US
Practice Address - Phone:901-345-6700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-26
Last Update Date:2019-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN25577363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily