Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | R215874 | MD |
N | 363LA2200X | Nurse Practitioner - Adult Health | 253445 | NC |
N | 363LA2200X | Nurse Practitioner - Adult Health | 834966 | TX |
NPI | 1023365988 |
---|---|
Provider Name | Brian Craig Fikes |
First Address | Ellicott City, MD 21042-5124 |
Second Address | Linthicum Heights, MD 21090 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/08/2012 |
Last Update Date | 10/09/2018 |