Provider Demographics
NPI:1841277340
Name:BRIGGS, BEVAN W (ARNP)
Entity type:Individual
Prefix:
First Name:BEVAN
Middle Name:W
Last Name:BRIGGS
Suffix:
Gender:M
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3900 S ZINTEL WAY
Mailing Address - Street 2:
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99338
Mailing Address - Country:US
Mailing Address - Phone:509-942-3627
Mailing Address - Fax:509-942-2268
Practice Address - Street 1:4804 W CLEARWATER AVE
Practice Address - Street 2:
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99336-2119
Practice Address - Country:US
Practice Address - Phone:509-942-2355
Practice Address - Fax:509-547-0827
Is Sole Proprietor?:No
Enumeration Date:2005-12-27
Last Update Date:2021-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30005530363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA3079BROtherBSWA
WA9633223Medicaid
605960011OtherUSDLAB
WA0220429OtherLIWA
WA3079BROtherBSWA
S82361Medicare UPIN
WAG8865949Medicare PIN