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NPI Code Detail

MEDICARE: MARTHA BROADDUS FNP

MEDICARE: MARTHA BROADDUS FNP
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 Practitioner41128TN

General Provider Information

NPI Number : 1801748553
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARTHA BROADDUS FNP
Provider Business Mailing Address
First Line : 1275 DICK LONAS RD
Second Line :
City : KNOXVILLE
State : TN
Zip : 37909-1382
Country : US
Telephone Number : 865-584-4747
Fax Number :
Provider Business Practice Location Address
First Line : 1825 KNOXVILLE HWY
Second Line :
City : WARTBURG
State : TN
Zip : 37887-4120
Country : US
Telephone Number : 423-346-3600
Fax Number : 833-908-2181
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/13/2026
Last Update Date : 02/13/2026

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Directions to “ MARTHA BROADDUS FNP” Practice Location

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