Provider Demographics
NPI:1710675558
Name:HARRIS, BRITTANI NICKIEL (RD)
Entity Type:Individual
Prefix:MRS
First Name:BRITTANI
Middle Name:NICKIEL
Last Name:HARRIS
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 BISHOP DR
Mailing Address - Street 2:
Mailing Address - City:MILLBROOK
Mailing Address - State:AL
Mailing Address - Zip Code:36054-3344
Mailing Address - Country:US
Mailing Address - Phone:706-573-1710
Mailing Address - Fax:
Practice Address - Street 1:12 BISHOP DR
Practice Address - Street 2:
Practice Address - City:MILLBROOK
Practice Address - State:AL
Practice Address - Zip Code:36054-3344
Practice Address - Country:US
Practice Address - Phone:706-573-1710
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-28
Last Update Date:2023-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2649133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered