Individual
JAMIE BRACKENRICH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
4521 BRAMBLETON AVE, SUITE 205, ROANOKE, VA 24018-2401
(540) 315-4766
Mailing address
4521 BRAMBLETON AVE STE 205, ROANOKE, VA 24018-3432
(540) 312-0105
(855) 592-1912
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
0024179822
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0024179822
VIRGINIA BOARD OF NURSING
VA
Enumeration date
08/24/2020
Last updated
02/18/2025
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