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General NPI Number Information
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NPI Number | 1457930703
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Entity Type | Individual
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Provider Name | BRANDY DENISE TATTERSON CPNP-PC
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Gender | Female
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Dates
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Enumeration Date | 04/05/2021
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Last Update Date | 08/25/2021
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Provider Practice Location Address
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Address Line | 109 EXETER ST
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City | MANTEO
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State | NC
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Zip | 27954-9400
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Country | US
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Telephone | 252-475-5038
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Fax |
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Provider Business Mailing Address
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Address Line | 109 EXETER ST
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City | MANTEO
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State | NC
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Zip | 27954-9400
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Country | US
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Telephone | 252-475-5038
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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 | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number | 5014941
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 163WC1500X
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Taxonomy Name | Community Health Registered Nurse
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License Number | 255031
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License Number State | NC
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