=====================================================
General NPI Number Information
=====================================================
NPI Number | 1003285305
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | BRITTANY L CANNON APN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/17/2015
-----------------------------------------------------
Last Update Date | 01/24/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 108 GRIFFITH ST
-----------------------------------------------------
City | SALE CREEK
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37373-9715
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 423-332-1813
-----------------------------------------------------
Fax | 423-648-7542
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 108 GRIFFITH ST
-----------------------------------------------------
City | SALE CREEK
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37373-9715
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 423-498-3570
-----------------------------------------------------
Fax | 423-648-7542
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LA2100X
-----------------------------------------------------
Taxonomy Name | Acute Care Nurse Practitioner
-----------------------------------------------------
License Number | 20250
-----------------------------------------------------
License Number State | TN
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | 20250
-----------------------------------------------------
License Number State | TN
-----------------------------------------------------