Provider Demographics
NPI:1174286652
Name:BROUGHTON, BRITTNEY (LPN)
Entity Type:Individual
Prefix:
First Name:BRITTNEY
Middle Name:
Last Name:BROUGHTON
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5352 CHUMAR DR UNIT 3
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31904-4662
Mailing Address - Country:US
Mailing Address - Phone:334-498-2475
Mailing Address - Fax:
Practice Address - Street 1:5352 CHUMAR DR UNIT 3
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31904-4662
Practice Address - Country:US
Practice Address - Phone:334-498-2475
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-20
Last Update Date:2021-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2-068763164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse