Healthcare Provider Details

I. General information

NPI: 1992634679
Provider Name (Legal Business Name): BRECKEN ELIZABETH OVERLY PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2026
Last Update Date: 05/18/2026
Certification Date: 05/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 W CALDWELL ST STE 100
MT JULIET TN
37122-3180
US

IV. Provider business mailing address

3669 HOGGETT FORD RD
HERMITAGE TN
37076-3512
US

V. Phone/Fax

Practice location:
  • Phone: 615-773-2712
  • Fax: 615-773-2712
Mailing address:
  • Phone: 615-773-2712
  • Fax: 615-773-2707

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number7061
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: