Provider Demographics
NPI:1124854658
Name:ALRED, BREYONNA N (N/A)
Entity type:Individual
Prefix:
First Name:BREYONNA
Middle Name:N
Last Name:ALRED
Suffix:
Gender:F
Credentials:N/A
Other - Prefix:
Other - First Name:BRE
Other - Middle Name:N
Other - Last Name:ALRED
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:N/A
Mailing Address - Street 1:201 ASHWOOD DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:TN
Mailing Address - Zip Code:38401-4303
Mailing Address - Country:US
Mailing Address - Phone:615-973-4965
Mailing Address - Fax:
Practice Address - Street 1:600 S JAMES M CAMPBELL BLVD
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:TN
Practice Address - Zip Code:38401-4334
Practice Address - Country:US
Practice Address - Phone:931-398-1757
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-11
Last Update Date:2024-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN229685376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide