Healthcare Provider Details

I. General information

NPI: 1326982786
Provider Name (Legal Business Name): BRIANA NICOLE MARTIN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/16/2026
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 LONDON MOUNTAIN VIEW DR STE 400
LONDON KY
40741-6669
US

IV. Provider business mailing address

10 TUIT ACRES RD
CORBIN KY
40701-6215
US

V. Phone/Fax

Practice location:
  • Phone: 606-260-8613
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number4054219
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: