Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | 123099 | OK |
NPI | 1003414145 |
---|---|
Provider Name | Kelsey Leigh Brittingham |
First Address | Bartlesville, OK 74006-2401 |
Second Address | Bartlesville, OK 74006-2401 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/10/2020 |
Last Update Date | 19/10/2021 |