Provider Demographics
NPI:1487943676
Name:CREEKMORE, BRAD F (FNP)
Entity type:Individual
Prefix:MR
First Name:BRAD
Middle Name:F
Last Name:CREEKMORE
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1335 FLOWERING DOGWOOD LN
Mailing Address - Street 2:
Mailing Address - City:DYERSBURG
Mailing Address - State:TN
Mailing Address - Zip Code:38024-2890
Mailing Address - Country:US
Mailing Address - Phone:731-286-2467
Mailing Address - Fax:731-286-1178
Practice Address - Street 1:1335 FLOWERING DOGWOOD LN
Practice Address - Street 2:
Practice Address - City:DYERSBURG
Practice Address - State:TN
Practice Address - Zip Code:38024-2890
Practice Address - Country:US
Practice Address - Phone:731-286-2467
Practice Address - Fax:731-286-1178
Is Sole Proprietor?:No
Enumeration Date:2011-03-29
Last Update Date:2011-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN167450163W00000X
TN15723363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse