1235449497 NPI number — STACY ANN BRINKLEY FNP

Table of content: STACY ANN BRINKLEY FNP (NPI 1235449497)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235449497 NPI number — STACY ANN BRINKLEY FNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BRINKLEY
Provider First Name:
STACY
Provider Middle Name:
ANN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
FNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1235449497
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/17/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
436 CLAIRMONT CT STE 105
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COLONIAL HEIGHTS
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23834-1765
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
757-562-2158
Provider Business Mailing Address Fax Number:
757-562-2134

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
22708 MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COURTLAND
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23837-1127
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
757-653-2007
Provider Business Practice Location Address Fax Number:
757-935-5551
Provider Enumeration Date:
10/20/2010

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  0024169005 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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