Provider Demographics
NPI:1356024996
Name:CARPENTER, BREANNA (FNP)
Entity type:Individual
Prefix:
First Name:BREANNA
Middle Name:
Last Name:CARPENTER
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5320 RODEO RIDGE LN
Mailing Address - Street 2:
Mailing Address - City:SEYMOUR
Mailing Address - State:TN
Mailing Address - Zip Code:37865-1700
Mailing Address - Country:US
Mailing Address - Phone:865-654-0501
Mailing Address - Fax:
Practice Address - Street 1:4410 VALLEY VIEW DR
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37917-1307
Practice Address - Country:US
Practice Address - Phone:865-523-5235
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-10
Last Update Date:2023-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN34434363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily