Healthcare Provider Details

I. General information

NPI: 1982355541
Provider Name (Legal Business Name): KANISHA L BRINSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/15/2022
Last Update Date: 01/15/2022
Certification Date: 01/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 W MAIN ST
GREENFIELD IN
46140-2387
US

IV. Provider business mailing address

1363 WHITE BIRCH LN
GREENFIELD IN
46140-7142
US

V. Phone/Fax

Practice location:
  • Phone: 317-517-8125
  • Fax:
Mailing address:
  • Phone: 317-517-8125
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: