MEDICARE: KRISTINA BRAGG

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	101YP2500X	Professional Counselor	6312	TN
2	101YP2500X	Professional Counselor

General Provider Information

NPI Number	:	1396492518
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTINA BRAGG

Provider Business Mailing Address
First Line	:	217 E MARKET ST STE 100
Second Line	:
City	:	JOHNSON CITY
State	:	TN
Zip	:	37601-4875
Country	:	US
Telephone Number	:	423-207-3336
Fax Number	:

Provider Business Practice Location Address
First Line	:	5217 MARYLAND WAY
Second Line	:
City	:	BRENTWOOD
State	:	TN
Zip	:	37027-1400
Country	:	US
Telephone Number	:	615-882-1792
Fax Number	:

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

Provider Enumeration Date	:	03/08/2022
Last Update Date	:	11/20/2023

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Directions to “ KRISTINA BRAGG ” Practice Location

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