Provider Demographics
NPI:1659691418
Name:MILLER, WENDY BRADEN (NP-C)
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:BRADEN
Last Name:MILLER
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:WENDY
Other - Middle Name:GAIL
Other - Last Name:BRADEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1035
Mailing Address - Street 2:
Mailing Address - City:LAKE CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37769-1035
Mailing Address - Country:US
Mailing Address - Phone:865-426-8061
Mailing Address - Fax:865-426-9200
Practice Address - Street 1:106 CREEK ST
Practice Address - Street 2:
Practice Address - City:LAKE CITY
Practice Address - State:TN
Practice Address - Zip Code:37769-2520
Practice Address - Country:US
Practice Address - Phone:865-426-8061
Practice Address - Fax:865-426-9200
Is Sole Proprietor?:No
Enumeration Date:2010-06-03
Last Update Date:2013-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN15017363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner