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General NPI Number Information
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NPI Number | 1457340598
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Entity Type | Individual
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Provider Name | BRENDA JESSEE FNP
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Gender | Female
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Dates
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Enumeration Date | 10/20/2005
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Last Update Date | 01/28/2025
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Provider Practice Location Address
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Address Line | 495 EAST MAIN STREET
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City | LEBANON
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State | VA
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Zip | 24266-4510
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Country | US
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Telephone | 276-889-3700
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Fax | 276-889-5505
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Provider Business Mailing Address
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Address Line | 1021 W OAKLAND AVE STE 310
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City | JOHNSON CITY
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State | TN
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Zip | 37604-2192
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Country | US
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Telephone | 423-952-2111
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Fax | 423-282-1657
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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 | 21969
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 0017000636
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License Number State | VA
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