Healthcare Provider Details

I. General information

NPI: 1467093302
Provider Name (Legal Business Name): BRADLEY QUINLEY NURSE PRACTITIONER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/02/2019
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1048 BLINKEN ST
KNOXVILLE TN
37932-3705
US

IV. Provider business mailing address

1048 BLINKEN ST
KNOXVILLE TN
37932-3705
US

V. Phone/Fax

Practice location:
  • Phone: 865-604-1890
  • Fax: 865-351-5272
Mailing address:
  • Phone: 865-604-1890
  • Fax: 865-351-5272

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number42759
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: