Healthcare Provider Details

I. General information

NPI: 1881512747
Provider Name (Legal Business Name): BRITTNEY HAWK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2026
Last Update Date: 07/08/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16555 MANCHESTER RD STE 100
WILDWOOD MO
63040-1220
US

IV. Provider business mailing address

64 LAKEFIELD PLACE CT APT A
WILDWOOD MO
63040-2111
US

V. Phone/Fax

Practice location:
  • Phone: 636-458-0646
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: