Individual provider Active NPI

Leslie Danielle Brietenmoser

  • Psychiatric/Mental Health Nurse Practitioner
  • Clarksville, TN
National Provider Identifier
1205590213
Registry record updated Oct 26, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
License
30235 Issued in TN
Practice address
103 Jefferson St Ste 100
Clarksville, TN 37040-8681
Phone
(931) 624-5651
NPI assigned
Oct 26, 2021
Last updated
Oct 26, 2021By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 26, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric/Mental Health Nurse Practitioner 363LP0808X 30235 TN Primary

Addresses

Primary practice location

103 Jefferson St Ste 100
Clarksville, TN 37040-8681

Mailing address

103 Jefferson St Ste 100
Clarksville, TN 37040-8681

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20220516001244 TN Practitioner - Nurse Practitioner 4981081890 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
East Tennessee State University Quillen College of Medicine, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Belmont Behavioral Health LLCGroup PAC ID 7517209968, 2 clinicians

Practice addresses (Care Compare)

103 Jefferson St
Suite 100
Clarksville, TN 37040-8681
Phone (931) 266-4999

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
30235TNMDPsychiatric/Mental Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Belmont Behavioral Health, LLC CurrentSince Mar 1, 2022 Accepting new patients

Locations

103 Jefferson St
Ste 100
Clarksville, TN 37040
Phone (931) 221-2881

2250 Wilma Rudolph Blvd
#F247
Clarksville, TN 37040

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1635206400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1635206400000",
    "number": "1205590213",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "103 JEFFERSON ST STE 100",
            "city": "CLARKSVILLE",
            "state": "TN",
            "postal_code": "370408681"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "103 JEFFERSON ST STE 100",
            "city": "CLARKSVILLE",
            "state": "TN",
            "postal_code": "370408681",
            "telephone_number": "931-624-5651"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRIETENMOSER",
        "first_name": "LESLIE",
        "middle_name": "DANIELLE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-10-26",
        "last_updated": "2021-10-26",
        "certification_date": "2021-10-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "TN",
            "license": "30235",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Clarksville, TN

Sources for this page

Verify at the official NPI Registry.