Provider Demographics
NPI:1114975315
Name:PETERSON, BRITTANY ALESE (FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:BRITTANY
Middle Name:ALESE
Last Name:PETERSON
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2201 MAIN STREET SUITE 214
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75201
Mailing Address - Country:US
Mailing Address - Phone:972-349-9211
Mailing Address - Fax:972-349-9255
Practice Address - Street 1:2201 MAIN STREET SUITE 214
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75201
Practice Address - Country:US
Practice Address - Phone:972-349-9211
Practice Address - Fax:972-349-9255
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-04
Last Update Date:2022-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX662870207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1743544-01Medicaid
TX8N8485OtherBCBS
TX8D4928Medicare ID - Type Unspecified
TX1743544-01Medicaid