1447590864 NPI number — BRITTNEY RENAE SIVILS APN

Table of content: BRITTNEY RENAE SIVILS APN (NPI 1447590864)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1447590864 NPI number — BRITTNEY RENAE SIVILS APN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SIVILS
Provider First Name:
BRITTNEY
Provider Middle Name:
RENAE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
APN
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:
1447590864
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/22/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 402319
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ATLANTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30384-2319
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
479-709-7399
Provider Business Mailing Address Fax Number:
479-709-7053

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1500 DODSON AVE
Provider Second Line Business Practice Location Address:
STE 60
Provider Business Practice Location Address City Name:
FORT SMITH
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
72901-5182
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
479-709-7317
Provider Business Practice Location Address Fax Number:
479-709-7335
Provider Enumeration Date:
02/21/2013

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:  A003824 , registered in the state of AR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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