Provider Demographics
NPI:1649456062
Name:GLASS, MALCOLM BRIAN (APN)
Entity type:Individual
Prefix:MR
First Name:MALCOLM
Middle Name:BRIAN
Last Name:GLASS
Suffix:
Gender:M
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 ALLEN DR
Mailing Address - Street 2:
Mailing Address - City:HENDERSONVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37075-3827
Mailing Address - Country:US
Mailing Address - Phone:615-596-7654
Mailing Address - Fax:
Practice Address - Street 1:317 SEVEN SPRINGS WAY STE 201
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:TN
Practice Address - Zip Code:37027-4511
Practice Address - Country:US
Practice Address - Phone:615-846-4558
Practice Address - Fax:615-461-1726
Is Sole Proprietor?:No
Enumeration Date:2008-01-16
Last Update Date:2024-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN13198363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health