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: 06/11/2026
Certification Date: 06/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

208 RANDOLPH ST
EDMONTON KY
42129-8175
US

IV. Provider business mailing address

208 RANDOLPH ST
EDMONTON KY
42129-8175
US

V. Phone/Fax

Practice location:
  • Phone: 270-432-3359
  • Fax:
Mailing address:
  • Phone: 270-432-3359
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW00001064
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: