Provider Demographics
NPI:1760040349
Name:BRITTAIN, JESSICA DIANN (ACAG-NP)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:DIANN
Last Name:BRITTAIN
Suffix:
Gender:F
Credentials:ACAG-NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2501 LAKEVIEW DR
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79109-1531
Mailing Address - Country:US
Mailing Address - Phone:806-350-8277
Mailing Address - Fax:
Practice Address - Street 1:2501 LAKEVIEW DR
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79109-1531
Practice Address - Country:US
Practice Address - Phone:806-358-9400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-30
Last Update Date:2022-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX804657363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX804657OtherTEXAS BON