Provider Demographics
NPI:1235691668
Name:EDMISTON, BRITNEY RAE (NP)
Entity Type:Individual
Prefix:
First Name:BRITNEY
Middle Name:RAE
Last Name:EDMISTON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:BRITNEY
Other - Middle Name:RAE
Other - Last Name:THACKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5733 GUEST RIVER RD
Mailing Address - Street 2:
Mailing Address - City:NORTON
Mailing Address - State:VA
Mailing Address - Zip Code:24273-4009
Mailing Address - Country:US
Mailing Address - Phone:276-220-9260
Mailing Address - Fax:
Practice Address - Street 1:1990 HOLTON AVE E
Practice Address - Street 2:
Practice Address - City:BIG STONE GAP
Practice Address - State:VA
Practice Address - Zip Code:24219-3350
Practice Address - Country:US
Practice Address - Phone:276-523-3111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-04
Last Update Date:2019-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000025694363L00000X
VA0024177431363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner