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General NPI Number Information
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NPI Number | 1255906301
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Entity Type | Individual
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Provider Name | MIRANDA BROOKE PRATT PA
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Gender | Female
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Dates
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Enumeration Date | 05/21/2021
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Last Update Date | 08/10/2022
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Provider Practice Location Address
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Address Line | 1300 OLD WEISGARBER RD
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City | KNOXVILLE
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State | TN
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Zip | 37909-1291
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Country | US
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Telephone | 865-584-2146
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Fax | 865-500-6436
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Provider Business Mailing Address
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Address Line | 2166 E BROADWAY AVE
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City | MARYVILLE
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State | TN
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Zip | 37804-3035
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Country | US
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Telephone | 865-273-9024
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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 | 4355
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License Number State | TN
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