Provider Demographics
NPI:1770609034
Name:QUILLEN, BRENDA J
Entity type:Individual
Prefix:
First Name:BRENDA
Middle Name:J
Last Name:QUILLEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:BRENDA
Other - Middle Name:J
Other - Last Name:PARTIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:110 N TENNESSEE AVE
Mailing Address - Street 2:
Mailing Address - City:LA FOLLETTE
Mailing Address - State:TN
Mailing Address - Zip Code:37766-2425
Mailing Address - Country:US
Mailing Address - Phone:423-562-7426
Mailing Address - Fax:423-562-4403
Practice Address - Street 1:110 N TENNESSEE AVE
Practice Address - Street 2:
Practice Address - City:LA FOLLETTE
Practice Address - State:TN
Practice Address - Zip Code:37766-2425
Practice Address - Country:US
Practice Address - Phone:423-562-7426
Practice Address - Fax:423-562-4403
Is Sole Proprietor?:No
Enumeration Date:2007-03-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator