Provider Demographics
NPI:1225210909
Name:SMITH, BRITTANY LAINE (NP)
Entity Type:Individual
Prefix:MS
First Name:BRITTANY
Middle Name:LAINE
Last Name:SMITH
Suffix:
Gender:F
Credentials:NP
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 395
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:LA
Mailing Address - Zip Code:70722-0395
Mailing Address - Country:US
Mailing Address - Phone:225-683-3340
Mailing Address - Fax:225-683-3411
Practice Address - Street 1:11990 JACKSON STREET
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:LA
Practice Address - Zip Code:70722-0395
Practice Address - Country:US
Practice Address - Phone:225-683-3340
Practice Address - Fax:225-683-3411
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-04
Last Update Date:2008-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARN102149363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1026832Medicaid