Healthcare Provider Details

I. General information

NPI: 1124854658
Provider Name (Legal Business Name): BREYONNA N ALRED N/A
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BRE N ALRED N/A

II. Dates (important events)

Enumeration Date: 09/11/2024
Last Update Date: 09/11/2024
Certification Date: 09/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 S JAMES M CAMPBELL BLVD
COLUMBIA TN
38401-4334
US

IV. Provider business mailing address

201 ASHWOOD DR
COLUMBIA TN
38401-4303
US

V. Phone/Fax

Practice location:
  • Phone: 931-398-1757
  • Fax:
Mailing address:
  • Phone: 615-973-4965
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number229685
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: