Provider Demographics
NPI:1770065799
Name:ALBRITTON, BRENTON LEE (NP-C)
Entity type:Individual
Prefix:MR
First Name:BRENTON
Middle Name:LEE
Last Name:ALBRITTON
Suffix:
Gender:M
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 792
Mailing Address - Street 2:
Mailing Address - City:BASTROP
Mailing Address - State:LA
Mailing Address - Zip Code:71221-0792
Mailing Address - Country:US
Mailing Address - Phone:318-283-8887
Mailing Address - Fax:318-281-2559
Practice Address - Street 1:335 MAIN ST
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:LA
Practice Address - Zip Code:71260-5253
Practice Address - Country:US
Practice Address - Phone:318-292-2795
Practice Address - Fax:318-292-2785
Is Sole Proprietor?:No
Enumeration Date:2018-09-06
Last Update Date:2024-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP10188363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA723772OtherFAMILY NURSE PRACTITIONER
LA2488520Medicaid