Healthcare Provider Details

I. General information

NPI: 1548996556
Provider Name (Legal Business Name): BRIANNA CROSS AU.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2022
Last Update Date: 04/08/2025
Certification Date: 04/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3700 TESLA DR
WEST LAFAYETTE IN
47906-0812
US

IV. Provider business mailing address

3700 TESLA DR
WEST LAFAYETTE IN
47906-0812
US

V. Phone/Fax

Practice location:
  • Phone: 336-413-0815
  • Fax:
Mailing address:
  • Phone: 336-413-0815
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number30001075
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number23002814A
License Number StateIN
# 3
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberAY2906
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: