Healthcare Provider Details

I. General information

NPI: 1760212542
Provider Name (Legal Business Name): BRITTAY MICHELLE KUZNIAR QMHP-CS-BA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/06/2024
Last Update Date: 08/06/2024
Certification Date: 08/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

319 N 12TH ST STE I
CORSICANA TX
75110-4604
US

IV. Provider business mailing address

8915 HARRY HINES BLVD
DALLAS TX
75235-1717
US

V. Phone/Fax

Practice location:
  • Phone: 903-270-0885
  • Fax:
Mailing address:
  • Phone: 682-760-5508
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: