1497399919 NPI number — AMY DIANE BRIGMAN FNP-C

Table of content: AMY DIANE BRIGMAN FNP-C (NPI 1497399919)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497399919 NPI number — AMY DIANE BRIGMAN FNP-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BRIGMAN
Provider First Name:
AMY
Provider Middle Name:
DIANE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
FNP-C
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:
1497399919
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/29/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
112 TURTLE DOVE CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WARNER ROBINS
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
31088-6416
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
478-321-7317
Provider Business Mailing Address Fax Number:
478-633-5183

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
618 ORANGE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MACON
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
31201-2081
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
478-633-9079
Provider Business Practice Location Address Fax Number:
478-633-5183
Provider Enumeration Date:
10/29/2019

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:  5020931 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LF0000X , with the licence number: RN236405 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: RN236405 . This is a "NP LICENSURE" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: F08191038 . This is a "NP CERTIFICATION NUMBER" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".




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