Healthcare Provider Details

I. General information

NPI: 1487354288
Provider Name (Legal Business Name): BREANNA MEGAN URENA PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/09/2023
Last Update Date: 08/21/2023
Certification Date: 08/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 N HOLTZCLAW AVE # 101
CHATTANOOGA TN
37404-1211
US

IV. Provider business mailing address

275 CUMBERLAND BND
NASHVILLE TN
37228-1805
US

V. Phone/Fax

Practice location:
  • Phone: 866-816-0433
  • Fax:
Mailing address:
  • Phone: 615-726-3340
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number33562
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: