Provider Demographics
NPI:1164783387
Name:HARRISON, BRITTANY NICHOL (FNP)
Entity Type:Individual
Prefix:
First Name:BRITTANY
Middle Name:NICHOL
Last Name:HARRISON
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:PO BOX 21890
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-4115
Mailing Address - Country:US
Mailing Address - Phone:502-907-0356
Mailing Address - Fax:502-919-9780
Practice Address - Street 1:700 KIMBER LANE
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47715-2803
Practice Address - Country:US
Practice Address - Phone:812-476-7111
Practice Address - Fax:812-476-7117
Is Sole Proprietor?:No
Enumeration Date:2012-06-05
Last Update Date:2022-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71004067A363LF0000X
KY3013026363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN9815905OtherAETNA PIN
1554303OtherWELLCARE ID
INCS1817800169OtherCARESOURCE ID
KY7100498190Medicaid
IN201287400BOtherMEDICAID GROUP ID
KYPDZ000000063404OtherAETNA BETTER HEALTH OF KY PROVIDER ID NUMBER
IN000001155086OtherANTHEM ID
IN300015279Medicaid