Healthcare Provider Details

I. General information

NPI: 1003285305
Provider Name (Legal Business Name): BRITTANY L CANNON APN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BRITTANY L PRYOR

II. Dates (important events)

Enumeration Date: 09/17/2015
Last Update Date: 01/24/2024
Certification Date: 01/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

108 GRIFFITH ST
SALE CREEK TN
37373-9715
US

IV. Provider business mailing address

108 GRIFFITH ST
SALE CREEK TN
37373-9715
US

V. Phone/Fax

Practice location:
  • Phone: 423-332-1813
  • Fax: 423-648-7542
Mailing address:
  • Phone: 423-498-3570
  • Fax: 423-648-7542

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number20250
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number20250
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: