Healthcare Provider Details

I. General information

NPI: 1336516426
Provider Name (Legal Business Name): BRITTINY CLINTON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2015
Last Update Date: 08/25/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6520 E 82ND ST SUITE 212
INDIANAPOLIS IN
46250-3600
US

IV. Provider business mailing address

1427 W 86TH ST SUITE 582
INDIANAPOLIS IN
46260-2103
US

V. Phone/Fax

Practice location:
  • Phone: 317-804-4247
  • Fax:
Mailing address:
  • Phone: 317-804-4247
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1744P3200X
TaxonomyProsthetics Case Management
License NumberBC21302351
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code1744P3200X
TaxonomyProsthetics Case Management
License NumberCO121923
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: