Provider Demographics
NPI:1528011426
Name:TEEFTALLER, BRANDON DESHON (APN)
Entity Type:Individual
Prefix:MR
First Name:BRANDON
Middle Name:DESHON
Last Name:TEEFTALLER
Suffix:
Gender:M
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2200 21ST AVE S
Mailing Address - Street 2:SUITE 406
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37212-4942
Mailing Address - Country:US
Mailing Address - Phone:615-301-8681
Mailing Address - Fax:615-301-1603
Practice Address - Street 1:2200 21ST AVE S
Practice Address - Street 2:SUITE 406
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37212-4942
Practice Address - Country:US
Practice Address - Phone:615-301-8681
Practice Address - Fax:615-301-1603
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-19
Last Update Date:2012-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN7967363LP0808X
TN7967363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN39084601Medicare UPIN