Provider Demographics
NPI:1124745534
Name:CHURCH, BRITTNEY D
Entity type:Individual
Prefix:
First Name:BRITTNEY
Middle Name:D
Last Name:CHURCH
Suffix:
Gender:F
Credentials:
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 31
Mailing Address - Street 2:
Mailing Address - City:KIMBALL
Mailing Address - State:WV
Mailing Address - Zip Code:24853-0031
Mailing Address - Country:US
Mailing Address - Phone:304-888-6794
Mailing Address - Fax:
Practice Address - Street 1:407 EDITH RD
Practice Address - Street 2:
Practice Address - City:KIMBALL
Practice Address - State:WV
Practice Address - Zip Code:24853-1102
Practice Address - Country:US
Practice Address - Phone:304-888-6794
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-26
Last Update Date:2022-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant