Doctor Name: | BAR-BRA FAI GLISSON |
NPI Number: | 1174815674 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | APRN |
License Number: | APN15458 |
Business Practice Address: | 920 University Street Martin, TN - 38237 |
Business Phone Number: | 7315878807 |
Business Fax Number: | 7315878810 |
Mailing Address: | 920 University St, MARTIN |
State: | TN |
Postal Code: | 382371605 |
Phone Number: | 7315878807 |
Fax Number: | 7315878810 |
NPI Enumeration Date: | 05/03/2011 |
NPI Last Update Date: | 02/21/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | APN15458 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | TN |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |