Provider Demographics
NPI:1295143741
Name:REYNOLDS, BRANDY (APN)
Entity type:Individual
Prefix:
First Name:BRANDY
Middle Name:
Last Name:REYNOLDS
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 OAK RIDGE TPKE
Mailing Address - Street 2:SUITE C-200
Mailing Address - City:OAK RIDGE
Mailing Address - State:TN
Mailing Address - Zip Code:37830-6957
Mailing Address - Country:US
Mailing Address - Phone:865-483-3594
Mailing Address - Fax:865-483-4910
Practice Address - Street 1:800 OAK RIDGE TPKE
Practice Address - Street 2:SUITE C-200
Practice Address - City:OAK RIDGE
Practice Address - State:TN
Practice Address - Zip Code:37830-6957
Practice Address - Country:US
Practice Address - Phone:865-483-3594
Practice Address - Fax:865-483-4910
Is Sole Proprietor?:No
Enumeration Date:2014-07-29
Last Update Date:2017-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN18945363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner