Healthcare Provider Details

I. General information

NPI: 1376466912
Provider Name (Legal Business Name): BRITTANI SELF
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2026
Last Update Date: 07/31/2026
Certification Date: 07/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6851 ATTALA ROAD 4202
SALLIS MS
39160-5648
US

IV. Provider business mailing address

6851 ATTALA ROAD 4202
SALLIS MS
39160-5648
US

V. Phone/Fax

Practice location:
  • Phone: 601-259-8382
  • Fax:
Mailing address:
  • Phone: 601-259-8382
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number908543
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: