Provider Demographics
NPI:1710322615
Name:BRANTLEY, JENNIFER LAIRD (MD)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:LAIRD
Last Name:BRANTLEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10031 SHERRILL BLVD
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37932-3336
Mailing Address - Country:US
Mailing Address - Phone:865-540-1650
Mailing Address - Fax:865-246-4753
Practice Address - Street 1:10031 SHERRILL BLVD
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37932-3336
Practice Address - Country:US
Practice Address - Phone:865-540-1650
Practice Address - Fax:865-246-4753
Is Sole Proprietor?:No
Enumeration Date:2013-05-06
Last Update Date:2019-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD54911207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology