Healthcare Provider Details

I. General information

NPI: 1952605107
Provider Name (Legal Business Name): BRENDA R. DEXTER FNP C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/03/2011
Last Update Date: 07/30/2020
Certification Date: 07/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

702 SHERRILL ST STE B
UNION CITY TN
38261-5891
US

IV. Provider business mailing address

702 SHERRILL ST STE B
UNION CITY TN
38261-5891
US

V. Phone/Fax

Practice location:
  • Phone: 731-885-8884
  • Fax: 731-599-9713
Mailing address:
  • Phone: 731-885-8884
  • Fax: 731-599-9713

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number15457
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: