Healthcare Provider Details

I. General information

NPI: 1720533110
Provider Name (Legal Business Name): ALEXIS C. BRADDOCK NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/16/2016
Last Update Date: 06/02/2020
Certification Date: 06/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1321 MURFREESBORO PIKE STE 510
NASHVILLE TN
37217-2655
US

IV. Provider business mailing address

3153 LANGLEY DR
FRANKLIN TN
37064-6221
US

V. Phone/Fax

Practice location:
  • Phone: 615-367-1860
  • Fax: 615-367-1861
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number21567
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: