Provider Demographics
NPI:1679205629
Name:STARK, BRIANNE MARY (RN, CLC)
Entity Type:Individual
Prefix:MRS
First Name:BRIANNE
Middle Name:MARY
Last Name:STARK
Suffix:
Gender:F
Credentials:RN, CLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:414 LOVE BIRD LN
Mailing Address - Street 2:
Mailing Address - City:MURPHY
Mailing Address - State:TX
Mailing Address - Zip Code:75094-3263
Mailing Address - Country:US
Mailing Address - Phone:715-379-9413
Mailing Address - Fax:
Practice Address - Street 1:414 LOVE BIRD LN
Practice Address - Street 2:
Practice Address - City:MURPHY
Practice Address - State:TX
Practice Address - Zip Code:75094-3263
Practice Address - Country:US
Practice Address - Phone:715-379-9413
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-28
Last Update Date:2022-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX921933163WM0102X, 163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant
No163WM0102XNursing Service ProvidersRegistered NurseMaternal Newborn