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General NPI Number Information
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NPI Number | 1134193618
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Entity Type | Individual
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Provider Name | BRENDA WATERS NP
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Gender | Female
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Dates
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Enumeration Date | 02/14/2006
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Last Update Date | 03/29/2021
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Provider Practice Location Address
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Address Line | 915 CLINGAN RIDGE DR NW
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City | CLEVELAND
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State | TN
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Zip | 37312-3729
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Country | US
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Telephone | 423-339-3340
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Fax | 423-339-9927
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Provider Business Mailing Address
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Address Line | 1021 EXECUTIVE DR SUITE 102
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City | HIXSON
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State | TN
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Zip | 37343-7918
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Country | US
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Telephone | 423-870-0046
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Fax | 423-870-0704
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 40095
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 40095
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License Number State | TN
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Taxonomy #3
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 40095
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License Number State | TN
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