MEDICARE: MEGAN BRACKETT

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	363A00000X	Physician Assistant	4669	TN

General Provider Information

NPI Number	:	1720730955
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MEGAN BRACKETT

Provider Business Mailing Address
First Line	:	9435 S NORTHSHORE DR
Second Line	:
City	:	KNOXVILLE
State	:	TN
Zip	:	37922-6550
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	9435 S NORTHSHORE DR
Second Line	:
City	:	KNOXVILLE
State	:	TN
Zip	:	37922-6550
Country	:	US
Telephone Number	:	865-769-2180
Fax Number	:

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

Provider Enumeration Date	:	01/19/2022
Last Update Date	:	01/28/2026

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Directions to “ MEGAN BRACKETT ” Practice Location

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