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NPI Code Detail

MEDICARE: BRANTLEY ALLEN THIGPEN

MEDICARE:   BRANTLEY ALLEN THIGPEN
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
1390200000XStudent in an Organized Health Care Education/Training Program

General Provider Information

NPI Number : 1639728355
Entity Type Code : Individual
Provider Name (Legal Business Name) : BRANTLEY ALLEN THIGPEN
Provider Business Mailing Address
First Line : 2128
Second Line : FELLOWSHID RD
City : MOUNT JULIET
State : TN
Zip : 37122
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2128
Second Line : FELLOWSHID RD
City : MOUNT JULIET
State : TN
Zip : 37122
Country : US
Telephone Number : 615-906-5669
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/05/2019
Last Update Date : 09/05/2019

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Directions to “ BRANTLEY ALLEN THIGPEN ” Practice Location

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