Provider Demographics
NPI:1336516426
Name:CLINTON, BRITTINY
Entity Type:Individual
Prefix:
First Name:BRITTINY
Middle Name:
Last Name:CLINTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1427 W 86TH ST
Mailing Address - Street 2:SUITE 582
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46260-2103
Mailing Address - Country:US
Mailing Address - Phone:317-804-4247
Mailing Address - Fax:
Practice Address - Street 1:6520 E 82ND ST
Practice Address - Street 2:SUITE 212
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46250-3600
Practice Address - Country:US
Practice Address - Phone:317-804-4247
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-25
Last Update Date:2015-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
INBC213023511744P3200X
GACO1219231744P3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case Management