MEDICARE: MILISSA A BRITT

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	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1538638648
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MILISSA A BRITT

Provider Business Mailing Address
First Line	:	9473 HIGHWAY 58
Second Line	:
City	:	RINGWOOD
State	:	OK
Zip	:	73768-5818
Country	:	US
Telephone Number	:	918-285-2765
Fax Number	:

Provider Business Practice Location Address
First Line	:	500 S NICKERSON
Second Line	:
City	:	WAYNOKA
State	:	OK
Zip	:	73860
Country	:	US
Telephone Number	:	580-824-0674
Fax Number	:

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

Provider Enumeration Date	:	11/19/2018
Last Update Date	:	11/20/2018

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