Provider Demographics
NPI:1295155844
Name:ACKLEY, BRITTANY (MD)
Entity type:Individual
Prefix:DR
First Name:BRITTANY
Middle Name:
Last Name:ACKLEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4077 JEFFERSON AVE
Mailing Address - Street 2:
Mailing Address - City:TEXARKANA
Mailing Address - State:AR
Mailing Address - Zip Code:71854-1509
Mailing Address - Country:US
Mailing Address - Phone:903-614-5270
Mailing Address - Fax:903-614-5279
Practice Address - Street 1:3502 RICHMOND RD
Practice Address - Street 2:
Practice Address - City:TEXARKANA
Practice Address - State:TX
Practice Address - Zip Code:75503-0705
Practice Address - Country:US
Practice Address - Phone:903-614-5270
Practice Address - Fax:903-614-5279
Is Sole Proprietor?:No
Enumeration Date:2014-04-22
Last Update Date:2021-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
TXR4928207Q00000X
TX760422435207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP02599414OtherRR MCR
OK200883090AMedicaid
AR716046242OtherAHEC-SW FAMILY PRACTICE