Individual
BRADLEY S AVANS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
130 W RAVINE RD, KINGSPORT, TN 37660-3837
(423) 224-4000
(423) 224-4746
Mailing address
105 W STONE DR, SUITE 6A, KINGSPORT, TN 37660-3365
(423) 408-7220
(423) 408-7405
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
11668
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00013859
NHC CARE ADMINISTRATORS
—
05
—
100049539
—
TN
01
—
188879
ANTHEM BCBS
—
05
—
3635995
—
TN
01
—
4117096
BLUE SHIELD OF TN
—
Enumeration date
04/04/2006
Last updated
04/21/2014
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