Healthcare Provider Details

I. General information

NPI: 1720711013
Provider Name (Legal Business Name): MELISSA RENEE BROOKER FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2022
Last Update Date: 01/04/2024
Certification Date: 01/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 OAK RIDGE TPKE
OAK RIDGE TN
37830-6916
US

IV. Provider business mailing address

1275 DICK LONAS RD UNIT 101
KNOXVILLE TN
37909-1383
US

V. Phone/Fax

Practice location:
  • Phone: 865-483-3172
  • Fax: 833-908-2163
Mailing address:
  • Phone: 865-584-4747
  • Fax: 833-908-0998

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number32111
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF06221184
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: