Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 26708 | TN |
NPI | 1003288408 |
---|---|
Provider Name | Larica Brady |
First Address | Nashville, TN 37204-4701 |
Second Address | Nashville, TN 37232-2996 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/10/2015 |
Last Update Date | 04/02/2021 |