Individual
BRANDIE WISHON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1817 FAIROAKS RD, KINGSPORT, TN 37664-3101
(423) 863-7138
Mailing address
1817 FAIROAKS RD, KINGSPORT, TN 37664-3101
(423) 863-7138
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
RBT-21-175587
TN
Other
Enumeration date
01/08/2022
Last updated
01/08/2022
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