Healthcare Provider Details

I. General information

NPI: 1720809767
Provider Name (Legal Business Name): BLUE RIVER HEALTH SERVICES, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/22/2024
Last Update Date: 05/05/2026
Certification Date: 05/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2715 CHERT LN
RALEIGH NC
27610-7189
US

IV. Provider business mailing address

5540 CENTERVIEW DR STE 204 PMB 777298
RALEIGH NC
27606
US

V. Phone/Fax

Practice location:
  • Phone: 919-234-7798
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MS. BRITTANY L HICKLEN
Title or Position: OWNER
Credential: NP
Phone: 919-234-7798