Healthcare Provider Details

I. General information

NPI: 1417785460
Provider Name (Legal Business Name): BRITTANY N WELFORD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BRITTANY COOKE

II. Dates (important events)

Enumeration Date: 07/22/2024
Last Update Date: 12/04/2025
Certification Date: 12/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

714 WATTS AVE
PASCAGOULA MS
39567-4219
US

IV. Provider business mailing address

714 WATTS AVE
PASCAGOULA MS
39567-4219
US

V. Phone/Fax

Practice location:
  • Phone: 228-227-4044
  • Fax:
Mailing address:
  • Phone: 228-227-4044
  • Fax: 516-464-1972

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number3672
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: