Provider Demographics
NPI:1356339055
Name:BRILEY, JOHN MICHAEL (DNP)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:MICHAEL
Last Name:BRILEY
Suffix:
Gender:M
Credentials:DNP
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 9274
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38314-9274
Mailing Address - Country:US
Mailing Address - Phone:731-427-0470
Mailing Address - Fax:731-427-0995
Practice Address - Street 1:1385 S HIGHLAND AVE
Practice Address - Street 2:SUITE B1
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38301-7580
Practice Address - Country:US
Practice Address - Phone:731-427-0470
Practice Address - Fax:731-427-0995
Is Sole Proprietor?:No
Enumeration Date:2005-10-07
Last Update Date:2011-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN6912363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4154631OtherBLUE CROSS BLUE SHIELD
TN5441759Medicaid
TN3342429Medicare PIN
TN4154631OtherBLUE CROSS BLUE SHIELD