Healthcare Provider Details

I. General information

NPI: 1326561069
Provider Name (Legal Business Name): BRITNEY PETTY RD LD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BRITNEY COWAN RD LD

II. Dates (important events)

Enumeration Date: 07/25/2017
Last Update Date: 08/27/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1823 COLLEGE AVE
MANHATTAN KS
66502-3381
US

IV. Provider business mailing address

2323 INDIAN MOUND LN
MANHATTAN KS
66502-2914
US

V. Phone/Fax

Practice location:
  • Phone: 785-776-2886
  • Fax: 785-565-4742
Mailing address:
  • Phone: 785-313-2777
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number1935
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: