Provider Demographics
NPI:1497719322
Name:CANTRELL, BRITTANY M (PA)
Entity Type:Individual
Prefix:
First Name:BRITTANY
Middle Name:M
Last Name:CANTRELL
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1021 W OAKLAND AVE
Mailing Address - Street 2:SUITE 301
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37604-2191
Mailing Address - Country:US
Mailing Address - Phone:423-952-8000
Mailing Address - Fax:423-952-8001
Practice Address - Street 1:1021 W OAKLAND AVE
Practice Address - Street 2:SUITE 301
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37604-2191
Practice Address - Country:US
Practice Address - Phone:423-952-8000
Practice Address - Fax:423-952-8001
Is Sole Proprietor?:No
Enumeration Date:2006-04-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNPA00911363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4043132OtherBCBS
TNTN01Q4OtherJOHN DEERE
TN4043132OtherBCBS
TN3670423Medicare ID - Type Unspecified