Provider Demographics
NPI:1720533110
Name:BRADDOCK, ALEXIS C (NP-C)
Entity type:Individual
Prefix:
First Name:ALEXIS
Middle Name:C
Last Name:BRADDOCK
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3153 LANGLEY DR
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37064-6221
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1321 MURFREESBORO PIKE STE 510
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37217-2655
Practice Address - Country:US
Practice Address - Phone:615-367-1860
Practice Address - Fax:615-367-1861
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-16
Last Update Date:2020-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN21567363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily