Provider Demographics
NPI:1497302814
Name:BRANTLEY, JODI L (NP-C)
Entity Type:Individual
Prefix:MRS
First Name:JODI
Middle Name:L
Last Name:BRANTLEY
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7557B DANNAHER DR STE 225
Mailing Address - Street 2:
Mailing Address - City:POWELL
Mailing Address - State:TN
Mailing Address - Zip Code:37849-3568
Mailing Address - Country:US
Mailing Address - Phone:865-859-7330
Mailing Address - Fax:865-859-7339
Practice Address - Street 1:7557B DANNAHER DR STE 225
Practice Address - Street 2:
Practice Address - City:POWELL
Practice Address - State:TN
Practice Address - Zip Code:37849-3568
Practice Address - Country:US
Practice Address - Phone:865-859-7330
Practice Address - Fax:865-859-7339
Is Sole Proprietor?:No
Enumeration Date:2019-08-20
Last Update Date:2020-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN26112363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily