Healthcare Provider Details

I. General information

NPI: 1801017116
Provider Name (Legal Business Name): BRANDY ENOCH STEWART FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2007
Last Update Date: 07/09/2025
Certification Date: 07/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 W KINGSTON SPRINGS RD STE 104
KINGSTON SPRINGS TN
37082-9121
US

IV. Provider business mailing address

127 CRESTVIEW PARK DR STE 209
DICKSON TN
37055-2856
US

V. Phone/Fax

Practice location:
  • Phone: 615-952-2011
  • Fax: 615-952-5216
Mailing address:
  • Phone: 615-446-5121
  • Fax: 615-446-1359

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPN12257
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: