1790146231 NPI number — BRITTANY NAOMI RUIZ PA-C

Table of content: BRITTANY NAOMI RUIZ PA-C (NPI 1790146231)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790146231 NPI number — BRITTANY NAOMI RUIZ PA-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RUIZ
Provider First Name:
BRITTANY
Provider Middle Name:
NAOMI
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PA-C
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BROWN
Provider Other First Name:
BRITTANY
Provider Other Middle Name:
NAOMI
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1790146231
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/29/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1923 SULPHUR SPRINGS RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MORRISTOWN
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37813-5654
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
423-317-9344
Provider Business Mailing Address Fax Number:
423-714-2355

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
501 ADESA BLVD STE A150
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LENOIR CITY
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37771-6719
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
865-986-8082
Provider Business Practice Location Address Fax Number:
865-986-5890
Provider Enumeration Date:
03/11/2016

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: 363A00000X , with the licence number:  6083 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 363A00000X , with the licence number: PA60725219 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 2077227 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".