Provider Demographics
NPI:1023828076
Name:FLANAGAN, BRAYDEN (MHS, PA-C, ATC)
Entity type:Individual
Prefix:
First Name:BRAYDEN
Middle Name:
Last Name:FLANAGAN
Suffix:
Gender:M
Credentials:MHS, PA-C, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:607 HIGHWAY 76
Mailing Address - Street 2:
Mailing Address - City:WHITE HOUSE
Mailing Address - State:TN
Mailing Address - Zip Code:37188-9206
Mailing Address - Country:US
Mailing Address - Phone:615-616-9415
Mailing Address - Fax:
Practice Address - Street 1:607 HIGHWAY 76
Practice Address - Street 2:
Practice Address - City:WHITE HOUSE
Practice Address - State:TN
Practice Address - Zip Code:37188-9206
Practice Address - Country:US
Practice Address - Phone:615-616-9415
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-11
Last Update Date:2025-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
2255A2300X
TN6352363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer