Provider Demographics
NPI:1942306006
Name:BRUMMITTE, PHYLLIS (NP)
Entity Type:Individual
Prefix:
First Name:PHYLLIS
Middle Name:
Last Name:BRUMMITTE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5127
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37602-5127
Mailing Address - Country:US
Mailing Address - Phone:866-397-1439
Mailing Address - Fax:423-262-1373
Practice Address - Street 1:96 15TH ST NW
Practice Address - Street 2:104
Practice Address - City:NORTON
Practice Address - State:VA
Practice Address - Zip Code:24273-1620
Practice Address - Country:US
Practice Address - Phone:276-679-8890
Practice Address - Fax:276-679-9740
Is Sole Proprietor?:No
Enumeration Date:2006-09-16
Last Update Date:2012-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024053074363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1942306006Medicaid
VA00X674N13Medicare PIN
S34303Medicare UPIN