Healthcare Provider Details

I. General information

NPI: 1699213983
Provider Name (Legal Business Name): BRITTNEY JESSIE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/07/2017
Last Update Date: 10/19/2022
Certification Date: 10/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 E FRAZIER AVE
COLUMBIA KY
42728-1915
US

IV. Provider business mailing address

130 SOUTHERN SCHOOL RD
SOMERSET KY
42501-3223
US

V. Phone/Fax

Practice location:
  • Phone: 270-384-4719
  • Fax:
Mailing address:
  • Phone: 606-679-4782
  • Fax: 606-677-5296

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225C00000X
TaxonomyRehabilitation Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number257102
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: