MEDICARE: KELSEY LEIGH BRITTINGHAM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	123099	OK
2	363L00000X	Nurse Practitioner	123099	OK

General Provider Information

NPI Number	:	1003414145
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELSEY LEIGH BRITTINGHAM

Provider Business Mailing Address
First Line	:	3450 E FRANK PHILLIPS BLVD STE 400
Second Line	:
City	:	BARTLESVILLE
State	:	OK
Zip	:	74006-2401
Country	:	US
Telephone Number	:	918-338-3740
Fax Number	:	918-338-3742

Provider Business Practice Location Address
First Line	:	3450 E FRANK PHILLIPS BLVD STE 400
Second Line	:
City	:	BARTLESVILLE
State	:	OK
Zip	:	74006-2401
Country	:	US
Telephone Number	:	918-338-3740
Fax Number	:	918-338-3742

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/12/2020
Last Update Date	:	10/19/2021

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