1770065799 NPI number — MR. BRENTON LEE ALBRITTON NP-C

Table of content: DR. KRISTEN L RANSONE DNP, APRN, FNP-C (NPI 1457597155)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770065799 NPI number — MR. BRENTON LEE ALBRITTON NP-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ALBRITTON
Provider First Name:
BRENTON
Provider Middle Name:
LEE
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
NP-C
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:
1770065799
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/09/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 792
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BASTROP
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
71221-0792
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
318-283-8887
Provider Business Mailing Address Fax Number:
318-281-2559

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
335 MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MARION
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
71260-5253
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
318-292-2795
Provider Business Practice Location Address Fax Number:
318-292-2785
Provider Enumeration Date:
09/06/2018

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:  AP10188 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 723772 . This is a "FAMILY NURSE PRACTITIONER" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".
  • Identifier: 2488520 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".




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