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General NPI Number Information
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NPI Number | 1356953053
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Entity Type | Individual
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Provider Name | JAMIE BRACKENRICH FNP
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Gender | Female
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Dates
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Enumeration Date | 08/24/2020
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Last Update Date | 02/18/2025
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Provider Practice Location Address
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Address Line | 4521 BRAMBLETON AVE SUITE 205
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City | ROANOKE
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State | VA
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Zip | 24018-2401
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Country | US
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Telephone | 540-315-4766
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Fax |
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Provider Business Mailing Address
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Address Line | 4521 BRAMBLETON AVE STE 205
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City | ROANOKE
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State | VA
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Zip | 24018-3432
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Country | US
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Telephone | 540-312-0105
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Fax | 855-592-1912
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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 | 0024179822
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License Number State | VA
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