Healthcare Provider Details

I. General information

NPI: 1750906335
Provider Name (Legal Business Name): BRAY FAMILY HEALTH AND WELLNESS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/10/2020
Last Update Date: 08/28/2020
Certification Date: 08/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35 SPIVEY ST
RED BOILING SPRINGS TN
37150-2078
US

IV. Provider business mailing address

35 SPIVEY ST
RED BOILING SPRINGS TN
37150-2078
US

V. Phone/Fax

Practice location:
  • Phone: 615-699-7425
  • Fax: 615-699-7427
Mailing address:
  • Phone: 615-699-7425
  • Fax: 615-699-7427

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: BEVERLY J COLTER
Title or Position: OFFICE MANAGER
Credential:
Phone: 615-699-7425