Healthcare Provider Details

I. General information

NPI: 1053802926
Provider Name (Legal Business Name): BRITTANY CHARLENE WICKWARE CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/25/2018
Last Update Date: 01/20/2020
Certification Date: 01/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28490 2ND ST STE B
DAPHNE AL
36526-7150
US

IV. Provider business mailing address

30417 PINYON DR
SPANISH FORT AL
36527-8727
US

V. Phone/Fax

Practice location:
  • Phone: 251-308-9800
  • Fax: 877-413-5104
Mailing address:
  • Phone: 251-233-1075
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number1-127339
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberAPRN11000136
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number1-127339
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: