Provider Demographics
NPI:1386216729
Name:BRINNER, ANGEL
Entity Type:Individual
Prefix:
First Name:ANGEL
Middle Name:
Last Name:BRINNER
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 1:2090 HIGHWAY 61 N
Mailing Address - Street 2:
Mailing Address - City:PORT GIBSON
Mailing Address - State:MS
Mailing Address - Zip Code:39150-4263
Mailing Address - Country:US
Mailing Address - Phone:601-437-8185
Mailing Address - Fax:601-437-4888
Practice Address - Street 1:2090 HIGHWAY 61 N
Practice Address - Street 2:
Practice Address - City:PORT GIBSON
Practice Address - State:MS
Practice Address - Zip Code:39150-4263
Practice Address - Country:US
Practice Address - Phone:601-437-8185
Practice Address - Fax:601-437-4888
Is Sole Proprietor?:No
Enumeration Date:2021-07-14
Last Update Date:2023-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No171M00000XOther Service ProvidersCase Manager/Care Coordinator