Provider Demographics
NPI:1316476872
Name:BREWER, BERNADETTE MICHELLE
Entity type:Individual
Prefix:
First Name:BERNADETTE
Middle Name:MICHELLE
Last Name:BREWER
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 1:5511 VIRGINIA WAY
Mailing Address - Street 2:STE 300
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-7611
Mailing Address - Country:US
Mailing Address - Phone:615-994-1000
Mailing Address - Fax:615-994-0100
Practice Address - Street 1:5511 VIRGINIA WAY
Practice Address - Street 2:STE 300
Practice Address - City:BRENTWOOD
Practice Address - State:TN
Practice Address - Zip Code:37027-7611
Practice Address - Country:US
Practice Address - Phone:615-994-1000
Practice Address - Fax:615-994-0100
Is Sole Proprietor?:No
Enumeration Date:2017-06-08
Last Update Date:2024-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN23448363LP0808X
TN173987163W00000X
VA0024190340363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse