Provider Demographics
NPI:1316906647
Name:BRAMLETTE, SHANNON B (MA)
Entity type:Individual
Prefix:MRS
First Name:SHANNON
Middle Name:B
Last Name:BRAMLETTE
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 699
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN HOME
Mailing Address - State:TN
Mailing Address - Zip Code:37684-0699
Mailing Address - Country:US
Mailing Address - Phone:276-466-3006
Mailing Address - Fax:
Practice Address - Street 1:1000 JASON WITTEN WAY
Practice Address - Street 2:
Practice Address - City:ELIZABETHTON
Practice Address - State:TN
Practice Address - Zip Code:37643-2970
Practice Address - Country:US
Practice Address - Phone:423-439-4355
Practice Address - Fax:423-543-0581
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2024-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA220100647231H00000X
VA2101001206237600000X
TN1696231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA009105468Medicaid
VA009460882Medicaid
TNQ004368Medicaid
VA1316906647Medicaid