Provider Demographics
NPI:1093557571
Name:BIRT, BREANN NICOLE
Entity type:Individual
Prefix:
First Name:BREANN
Middle Name:NICOLE
Last Name:BIRT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:240 MCCAULEYS BLUFF RD
Mailing Address - Street 2:
Mailing Address - City:HOLLADAY
Mailing Address - State:TN
Mailing Address - Zip Code:38341-2953
Mailing Address - Country:US
Mailing Address - Phone:731-220-0649
Mailing Address - Fax:
Practice Address - Street 1:29639 BROAD ST
Practice Address - Street 2:
Practice Address - City:BRUCETON
Practice Address - State:TN
Practice Address - Zip Code:38317-2203
Practice Address - Country:US
Practice Address - Phone:731-220-0649
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-06
Last Update Date:2024-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician