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NPI Code Detail

MEDICARE: GREENBRIER MEDICAL

MEDICARE: GREENBRIER MEDICAL
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
1363LF0000XFamily Nurse Practitioner13614TN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1APN 13614OTHERTNLICENSE

General Provider Information

NPI Number : 1285066407
Entity Type Code : Organization
Provider Name (Legal Business Name) : GREENBRIER MEDICAL
Provider Business Mailing Address
First Line : 1110 VILLAGE DR
Second Line :
City : SEVIERVILLE
State : TN
Zip : 37862-5028
Country : US
Telephone Number : 865-453-0792
Fax Number : 865-429-5006
Provider Business Practice Location Address
First Line : 1110 VILLAGE DR
Second Line :
City : SEVIERVILLE
State : TN
Zip : 37862-5028
Country : US
Telephone Number : 865-453-0792
Fax Number : 865-429-5006
Authorized Official
Title or Position : FAMILY NURSE PRACTITIONER
Name : MELISSA ANN LARGE
Credential : MSN, FNP
Telephone Number : 865-453-0792
Provider Enumeration Date : 07/30/2013
Last Update Date : 07/30/2013

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