MEDICARE: BREANNA CARPENTER FNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	34434	TN

General Provider Information

NPI Number	:	1356024996
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BREANNA CARPENTER FNP

Provider Business Mailing Address
First Line	:	5320 RODEO RIDGE LN
Second Line	:
City	:	SEYMOUR
State	:	TN
Zip	:	37865-1700
Country	:	US
Telephone Number	:	865-654-0501
Fax Number	:

Provider Business Practice Location Address
First Line	:	4410 VALLEY VIEW DR
Second Line	:
City	:	KNOXVILLE
State	:	TN
Zip	:	37917-1307
Country	:	US
Telephone Number	:	865-523-5235
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/10/2023
Last Update Date	:	08/10/2023

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