=====================================================
General NPI Number Information
=====================================================
NPI Number | 1942460787
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | BRITTANY NICOLE BYRD II
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/16/2008
-----------------------------------------------------
Last Update Date | 05/11/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 104 E EVERETT ST
-----------------------------------------------------
City | POCAHONTAS
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72455-3309
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 870-810-2835
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 674 PITMAN RD
-----------------------------------------------------
City | MAYNARD
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72444-9319
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 870-810-2835
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225700000X
-----------------------------------------------------
Taxonomy Name | Massage Therapist
-----------------------------------------------------
License Number | 9311
-----------------------------------------------------
License Number State | AR
-----------------------------------------------------