Healthcare Provider Details

I. General information

NPI: 1417403114
Provider Name (Legal Business Name): BRITTANY ANNE ISEMINGER-SMITH PA-C, ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: BRITTANY ANNE ISEMINGER ATC

II. Dates (important events)

Enumeration Date: 09/01/2016
Last Update Date: 08/03/2024
Certification Date: 08/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

499 CAMPUS DR
MARTINSBURG WV
25404-7534
US

IV. Provider business mailing address

80 TUCKAHOE TRL
HEDGESVILLE WV
25427-5593
US

V. Phone/Fax

Practice location:
  • Phone: 240-291-8648
  • Fax:
Mailing address:
  • Phone: 240-291-8648
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberC0009524
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberA00548
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberAT001377
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: