Provider Demographics
NPI:1598777260
Name:VESTAL, BRITTNEY D (FNP)
Entity Type:Individual
Prefix:
First Name:BRITTNEY
Middle Name:D
Last Name:VESTAL
Suffix:
Gender:F
Credentials:FNP
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 9
Mailing Address - Street 2:
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37662-0009
Mailing Address - Country:US
Mailing Address - Phone:423-857-2093
Mailing Address - Fax:423-390-3340
Practice Address - Street 1:240 MEDICAL PARK BLVD STE 3000
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:TN
Practice Address - Zip Code:37620-7352
Practice Address - Country:US
Practice Address - Phone:423-990-2400
Practice Address - Fax:423-990-2405
Is Sole Proprietor?:No
Enumeration Date:2006-08-12
Last Update Date:2019-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000010979363LF0000X, 363L00000X
VA0024166487363LF0000X
TN10979TN363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010201012Medicaid
TN1513447OtherAMERICHOICE TN CARE
TN1513447OtherAMERICHOICE TN CARE
VAQ52080Medicare UPIN
VA010201012Medicaid