Provider Demographics
NPI:1316509771
Name:CRUMMEY, BRIANNA JESSUP (NP)
Entity type:Individual
Prefix:
First Name:BRIANNA
Middle Name:JESSUP
Last Name:CRUMMEY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:309 BELL LINE RD
Mailing Address - Street 2:
Mailing Address - City:EASTMAN
Mailing Address - State:GA
Mailing Address - Zip Code:31023-2637
Mailing Address - Country:US
Mailing Address - Phone:478-231-9729
Mailing Address - Fax:
Practice Address - Street 1:911 PLAZA AVE STE C
Practice Address - Street 2:
Practice Address - City:EASTMAN
Practice Address - State:GA
Practice Address - Zip Code:31023-6786
Practice Address - Country:US
Practice Address - Phone:478-374-5774
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-05
Last Update Date:2019-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN258688363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily