MEDICARE: MRS. HANNAH MARIE BRADEN APRN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	APN0000024715	TN
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	APN0000024715	TN

General Provider Information

NPI Number	:	1265916241
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. HANNAH MARIE BRADEN APRN

Provider Business Mailing Address
First Line	:	421 WALLACE AVE
Second Line	:
City	:	ROCKY TOP
State	:	TN
Zip	:	37769-2637
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	421 WALLACE AVE
Second Line	:
City	:	ROCKY TOP
State	:	TN
Zip	:	37769-2637
Country	:	US
Telephone Number	:	423-201-3572
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/17/2018
Last Update Date	:	09/17/2018

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