Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LA2100X | Nurse Practitioner - Acute Care | 20250 | TN |
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 20250 | TN |
NPI | 1003285305 |
---|---|
Provider Name | Brittany L Cannon |
First Address | Sale Creek, TN 37373-9715 |
Second Address | Sale Creek, TN 37373-9715 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/09/2015 |
Last Update Date | 24/01/2022 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
20250 | APN LICENSE (01) | TN |