Healthcare Provider Details

I. General information

NPI: 1467104570
Provider Name (Legal Business Name): BROOKE BEDWELL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/20/2022
Last Update Date: 09/14/2023
Certification Date: 09/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

190 UNIVERSITY AVE
PARSONS TN
38363-2972
US

IV. Provider business mailing address

275 BUTLER RD
PARSONS TN
38363-3037
US

V. Phone/Fax

Practice location:
  • Phone: 731-257-1500
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number31059
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: