1265825392 NPI number — MR. BRITTANY NEWELL BRICKEN CRNP

Table of content: MR. BRITTANY NEWELL BRICKEN CRNP (NPI 1265825392)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265825392 NPI number — MR. BRITTANY NEWELL BRICKEN CRNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BRICKEN
Provider First Name:
BRITTANY
Provider Middle Name:
NEWELL
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
CRNP
Provider Gender Code:
M

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:
1265825392
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/18/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1130 22ND ST S
Provider Second Line Business Mailing Address:
RIDGE PARK PLACE, SUITE 1000
Provider Business Mailing Address City Name:
BIRMINGHAM
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
35205-2870
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3400 HIGHWAY 78 E
Provider Second Line Business Practice Location Address:
MEDICAL ARTS TOWER, SUITE 110
Provider Business Practice Location Address City Name:
JASPER
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35501-8956
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
205-221-1755
Provider Business Practice Location Address Fax Number:
205-221-9961
Provider Enumeration Date:
03/13/2015

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: 163WW0000X , with the licence number:  1-100374 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LF0000X , with the licence number: 1-100374 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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