Healthcare Provider Details

I. General information

NPI: 1023365988
Provider Name (Legal Business Name): BRIAN CRAIG FIKES ANP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2012
Last Update Date: 09/10/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 ELKRIDGE LANDING RD STE 100
LINTHICUM HEIGHTS MD
21090
US

IV. Provider business mailing address

3786 PLUM MEADOW DR
ELLICOTT CITY MD
21042-5124
US

V. Phone/Fax

Practice location:
  • Phone: 800-405-9681
  • Fax:
Mailing address:
  • Phone: 410-935-4258
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number253445
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number253445
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number834966
License Number StateTX
# 4
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberR215874
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: