Individual
MIRANDA BROOKE PRATT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
1300 OLD WEISGARBER RD, KNOXVILLE, TN 37909-1291
(865) 584-2146
(865) 500-6436
Mailing address
2166 E BROADWAY AVE, MARYVILLE, TN 37804-3035
(865) 273-9024
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
4355
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
Q066090
—
TN
Enumeration date
05/21/2021
Last updated
08/10/2022
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