Healthcare Provider Details

I. General information

NPI: 1356339055
Provider Name (Legal Business Name): JOHN MICHAEL BRILEY DNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/07/2005
Last Update Date: 11/08/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1385 S HIGHLAND AVE SUITE B1
JACKSON TN
38301-7580
US

IV. Provider business mailing address

PO BOX 9274
JACKSON TN
38314-9274
US

V. Phone/Fax

Practice location:
  • Phone: 731-427-0470
  • Fax: 731-427-0995
Mailing address:
  • Phone: 731-427-0470
  • Fax: 731-427-0995

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPN6912
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: