Healthcare Provider Details

I. General information

NPI: 1013700699
Provider Name (Legal Business Name): BRITTANI M HARRELSON PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2025
Last Update Date: 05/27/2025
Certification Date: 05/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

677 W LANE ST
EQUALITY IL
62934-1336
US

IV. Provider business mailing address

677 W LANE ST
EQUALITY IL
62934-1336
US

V. Phone/Fax

Practice location:
  • Phone: 618-927-0111
  • Fax:
Mailing address:
  • Phone: 618-927-0111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number209.029896
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: