Provider Demographics
NPI:1023279072
Name:BRACKETT, JESSICA ELIZABETH (PT)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:ELIZABETH
Last Name:BRACKETT
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 9118
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55480-9118
Mailing Address - Country:US
Mailing Address - Phone:865-694-7725
Mailing Address - Fax:865-524-5047
Practice Address - Street 1:1819 W CLINCH AVE STE 106
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37916-2435
Practice Address - Country:US
Practice Address - Phone:865-633-0259
Practice Address - Fax:865-524-5407
Is Sole Proprietor?:No
Enumeration Date:2008-06-23
Last Update Date:2022-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN8066225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1505589Medicaid
TN0677340001Medicare NSC
TN0677340005Medicare NSC
TN0677340003Medicare NSC
TN0677340004Medicare NSC
TN0677340010Medicare NSC
TN3650147Medicare PIN