Healthcare Provider Details

I. General information

NPI: 1700010816
Provider Name (Legal Business Name): MATTHEW A BRAYTON NP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/05/2009
Last Update Date: 05/05/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1850 OLD KNOXVILLE RD
TAZEWELL TN
37879-3625
US

IV. Provider business mailing address

1431 CENTERPOINT BLVD SUITE 100
KNOXVILLE TN
37932-1984
US

V. Phone/Fax

Practice location:
  • Phone: 865-985-7234
  • Fax: 865-985-7077
Mailing address:
  • Phone: 865-985-7234
  • Fax: 865-985-7077

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPN12262
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: