Provider Demographics
NPI:1639067077
Name:MOSS, BREANNA JADE
Entity type:Individual
Prefix:
First Name:BREANNA
Middle Name:JADE
Last Name:MOSS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2299 PIKE WOOD DR
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:38138-4624
Mailing Address - Country:US
Mailing Address - Phone:662-590-6203
Mailing Address - Fax:
Practice Address - Street 1:2725 KIRBY RD STE 11
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38119-8240
Practice Address - Country:US
Practice Address - Phone:901-800-4645
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-25
Last Update Date:2025-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program