Healthcare Provider Details

I. General information

NPI: 1952215212
Provider Name (Legal Business Name): RACHEL ISABELLA O'BRYAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/01/2026
Last Update Date: 10/01/2026
Certification Date: 10/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6965 CUMBERLAND GAP PKWY
HARROGATE TN
37752-8245
US

IV. Provider business mailing address

873 FROZEN BR
LEANDER KY
41222-8857
US

V. Phone/Fax

Practice location:
  • Phone: 423-869-3611
  • Fax:
Mailing address:
  • Phone: 606-793-1522
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number1168473
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: