Provider Demographics
NPI:1255943403
Name:WILSON, BRITTANY FAITH
Entity type:Individual
Prefix:MRS
First Name:BRITTANY
Middle Name:FAITH
Last Name:WILSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3520 GREENBRIER CREEK RD
Mailing Address - Street 2:
Mailing Address - City:FORT GAY
Mailing Address - State:WV
Mailing Address - Zip Code:25514-7306
Mailing Address - Country:US
Mailing Address - Phone:304-272-6832
Mailing Address - Fax:
Practice Address - Street 1:3520 GREENBRIER CREEK RD
Practice Address - Street 2:
Practice Address - City:FORT GAY
Practice Address - State:WV
Practice Address - Zip Code:25514-7306
Practice Address - Country:US
Practice Address - Phone:304-272-6832
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-19
Last Update Date:2020-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WVI318781Medicaid