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NPI Code Detail

MEDICARE: MRS. BERNADINE RENEE GRAHAM MSN, APRN, BC

MEDICARE: MRS. BERNADINE RENEE GRAHAM MSN, APRN, BC
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 PractitionerAPN0000005916TN

General Provider Information

NPI Number : 1659352151
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. BERNADINE RENEE GRAHAM MSN, APRN, BC
Provider Business Mailing Address
First Line : 618 ROCKINGHAM DR
Second Line :
City : KNOXVILLE
State : TN
Zip : 37909-2623
Country : US
Telephone Number : 865-584-8752
Fax Number :
Provider Business Practice Location Address
First Line : 140 DAMERON AVE
Second Line :
City : KNOXVILLE
State : TN
Zip : 37917-6413
Country : US
Telephone Number : 865-215-5440
Fax Number : 865-215-5450
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/10/2005
Last Update Date : 07/08/2007

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