Healthcare Provider Details

I. General information

NPI: 1598777260
Provider Name (Legal Business Name): BRITTNEY D. VESTAL FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2006
Last Update Date: 12/11/2019
Certification Date: 12/11/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

240 MEDICAL PARK BLVD STE 3000
BRISTOL TN
37620-7352
US

IV. Provider business mailing address

PO BOX 9
KINGSPORT TN
37662-0009
US

V. Phone/Fax

Practice location:
  • Phone: 423-990-2400
  • Fax: 423-990-2405
Mailing address:
  • Phone: 423-857-2093
  • Fax: 423-390-3340

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number0000010979
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0000010979
License Number StateTN
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024166487
License Number StateVA
# 4
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number10979TN
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: