Provider Demographics
NPI:1922345214
Name:HEADY, BRITTANY ANN (PA)
Entity Type:Individual
Prefix:MS
First Name:BRITTANY
Middle Name:ANN
Last Name:HEADY
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
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Mailing Address - Street 1:456 N NEW BALLAS RD STE 348
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-6846
Mailing Address - Country:US
Mailing Address - Phone:314-548-0265
Mailing Address - Fax:314-548-6555
Practice Address - Street 1:456 NEW NEW BALLAS
Practice Address - Street 2:SUITE 348
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141
Practice Address - Country:US
Practice Address - Phone:314-548-0265
Practice Address - Fax:314-548-6555
Is Sole Proprietor?:No
Enumeration Date:2013-01-07
Last Update Date:2021-04-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO2013000137363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILENROLLEDMedicaid