Healthcare Provider Details

I. General information

NPI: 1225957772
Provider Name (Legal Business Name): BRIANNE NICOLE COMBS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2026
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2240 COUNTY ROAD 1270
WILLOW SPRINGS MO
65793-3393
US

IV. Provider business mailing address

613 LANCE LN
WILLOW SPRINGS MO
65793-3456
US

V. Phone/Fax

Practice location:
  • Phone: 573-883-6761
  • Fax:
Mailing address:
  • Phone: 573-883-6761
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: