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General NPI Number Information
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NPI Number | 1235632712
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Entity Type | Individual
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Provider Name | BROOKE GUTHRIE PA-C
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Gender | Female
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Dates
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Enumeration Date | 03/12/2018
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Last Update Date | 02/15/2024
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Provider Practice Location Address
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Address Line | 9400 RHEA COUNTY HWY # ER
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City | DAYTON
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State | TN
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Zip | 37321-7922
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Country | US
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Telephone | 423-775-8642
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Fax |
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Provider Business Mailing Address
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Address Line | 500 HYATTE RD
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City | SODDY DAISY
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State | TN
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Zip | 37379-4011
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Country | US
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Telephone | 423-827-7658
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Fax |
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 3474
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License Number State | TN
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