Healthcare Provider Details

I. General information

NPI: 1669809232
Provider Name (Legal Business Name): BRANDI J MACKIN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/27/2013
Last Update Date: 09/27/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31 MEDICAL DR
LINDEN TN
37096-3326
US

IV. Provider business mailing address

2284 BURNS HILL RD
LOBELVILLE TN
37097-4623
US

V. Phone/Fax

Practice location:
  • Phone: 931-583-2138
  • Fax: 931-589-5414
Mailing address:
  • Phone: 931-593-2150
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License NumberRN0000156479
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: