Provider Demographics
NPI:1922680842
Name:GHOLSTON, BRITTANY SIMONE (RN)
Entity Type:Individual
Prefix:MR
First Name:BRITTANY
Middle Name:SIMONE
Last Name:GHOLSTON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2835 ZELDA RD STE 17
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36106-2667
Mailing Address - Country:US
Mailing Address - Phone:334-440-5122
Mailing Address - Fax:
Practice Address - Street 1:2835 ZELDA RD STE 17
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36106-2667
Practice Address - Country:US
Practice Address - Phone:334-320-6289
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-21
Last Update Date:2024-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-192780163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health