Individual
MS. BRENDA WATERS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
915 CLINGAN RIDGE DR NW, CLEVELAND, TN 37312-3729
(423) 339-3340
(423) 339-9927
Mailing address
1021 EXECUTIVE DR, SUITE 102, HIXSON, TN 37343-7918
(423) 870-0046
(423) 870-0704
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
40095
TN
363L00000X
Nurse Practitioner
Primary
40095
TN
363LF0000X
Family Nurse Practitioner
40095
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1134193618
—
TN
Enumeration date
02/14/2006
Last updated
03/29/2021
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