Provider Demographics
NPI:1336557917
Name:BRADNER, HEATHER NOELLE (FNP)
Entity Type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:NOELLE
Last Name:BRADNER
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:HEATHER
Other - Middle Name:NOELLE
Other - Last Name:PARKINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2210 SUTHERLAND AVE
Mailing Address - Street 2:SUITE 110
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37919
Mailing Address - Country:US
Mailing Address - Phone:865-525-4333
Mailing Address - Fax:865-212-8879
Practice Address - Street 1:2210 SUTHERLAND AVE
Practice Address - Street 2:SUITE 110
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37919
Practice Address - Country:US
Practice Address - Phone:865-525-4333
Practice Address - Fax:865-212-8879
Is Sole Proprietor?:No
Enumeration Date:2014-07-28
Last Update Date:2021-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN169974163W00000X
TN18936363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ008280Medicaid