Provider Demographics
NPI:1083495402
Name:CASTLE, BRITTANI KIANNA
Entity Type:Individual
Prefix:
First Name:BRITTANI
Middle Name:KIANNA
Last Name:CASTLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1550 LEONA ST APT 306
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77009-1578
Mailing Address - Country:US
Mailing Address - Phone:804-496-3966
Mailing Address - Fax:
Practice Address - Street 1:1550 LEONA ST APT 306
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77009-1578
Practice Address - Country:US
Practice Address - Phone:804-496-3966
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-11
Last Update Date:2023-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX45210056172A00000X, 347C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle
No172A00000XOther Service ProvidersDriver