Provider Demographics
NPI:1659559540
Name:SHORT, BRITT NICOLE (APRN/FNP)
Entity Type:Individual
Prefix:MRS
First Name:BRITT
Middle Name:NICOLE
Last Name:SHORT
Suffix:
Gender:F
Credentials:APRN/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 1215
Mailing Address - Street 2:ATTN CLINIC BILLING OFFICE
Mailing Address - City:LIBERAL
Mailing Address - State:KS
Mailing Address - Zip Code:67905-1215
Mailing Address - Country:US
Mailing Address - Phone:620-629-6638
Mailing Address - Fax:620-629-6684
Practice Address - Street 1:555 W 15TH ST
Practice Address - Street 2:STE A
Practice Address - City:LIBERAL
Practice Address - State:KS
Practice Address - Zip Code:67901-2467
Practice Address - Country:US
Practice Address - Phone:620-624-0702
Practice Address - Fax:620-624-5078
Is Sole Proprietor?:No
Enumeration Date:2008-02-04
Last Update Date:2017-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS53-46166363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200255920AMedicaid
KS200643940CMedicaid
OK200255920AMedicaid