Provider Demographics
NPI:1114545142
Name:HENRY, BRITTANY LEIGH (FNP)
Entity Type:Individual
Prefix:
First Name:BRITTANY
Middle Name:LEIGH
Last Name:HENRY
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:421 WHITE MOUNTAIN MEADOWS DR
Mailing Address - Street 2:
Mailing Address - City:RUIDOSO
Mailing Address - State:NM
Mailing Address - Zip Code:88345-5814
Mailing Address - Country:US
Mailing Address - Phone:903-341-0477
Mailing Address - Fax:
Practice Address - Street 1:710 AVENUE E
Practice Address - Street 2:
Practice Address - City:CARRIZOZO
Practice Address - State:NM
Practice Address - Zip Code:88301
Practice Address - Country:US
Practice Address - Phone:575-648-2317
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-07
Last Update Date:2020-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM60519363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily