Healthcare Provider Details

I. General information

NPI: 1902838808
Provider Name (Legal Business Name): DUSTIN JAMES BRIGGS ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 07/01/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

812 UNIVERSITY ST CAMPUS BOX 6600
PELLA IA
50219-1902
US

IV. Provider business mailing address

PO BOX 345
NEW SHARON IA
50207-0345
US

V. Phone/Fax

Practice location:
  • Phone: 641-628-5328
  • Fax:
Mailing address:
  • Phone: 641-780-8836
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number00529
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code146M00000X
TaxonomyIntermediate Emergency Medical Technician
License NumberAEMT-11-1000-09
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: