Provider Demographics
NPI:1649707357
Name:COAKER, BRYNNE MICHELLE (CNM)
Entity type:Individual
Prefix:
First Name:BRYNNE
Middle Name:MICHELLE
Last Name:COAKER
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:BRYNNE
Other - Middle Name:MICHELLE
Other - Last Name:TILLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:2817 REILLY RD.
Mailing Address - Street 2:
Mailing Address - City:FORT BRAGG
Mailing Address - State:NC
Mailing Address - Zip Code:28310-7324
Mailing Address - Country:US
Mailing Address - Phone:910-907-6000
Mailing Address - Fax:
Practice Address - Street 1:2817 REILLY RD.
Practice Address - Street 2:
Practice Address - City:FORT BRAGG
Practice Address - State:NC
Practice Address - Zip Code:28310-7324
Practice Address - Country:US
Practice Address - Phone:910-907-6000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-12
Last Update Date:2017-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS14-136805-102163W00000X
KS53-77373-102367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No163W00000XNursing Service ProvidersRegistered Nurse