MEDICARE: JUSTIN LYNN BRADSHAW RN

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	163W00000X	Registered Nurse	166351	TN

General Provider Information

NPI Number	:	1689519191
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JUSTIN LYNN BRADSHAW RN

Provider Business Mailing Address
First Line	:	134 PEACH ORCHARD RD
Second Line	:
City	:	CLINTON
State	:	TN
Zip	:	37716-6600
Country	:	US
Telephone Number	:	865-414-5298
Fax Number	:

Provider Business Practice Location Address
First Line	:	134 PEACH ORCHARD RD
Second Line	:
City	:	CLINTON
State	:	TN
Zip	:	37716-6600
Country	:	US
Telephone Number	:	865-414-5298
Fax Number	:

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

Provider Enumeration Date	:	04/21/2026
Last Update Date	:	04/21/2026

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