Provider Demographics
NPI:1154029239
Name:WEST, BRIGETTE NICOLE (QIDP)
Entity type:Individual
Prefix:
First Name:BRIGETTE
Middle Name:NICOLE
Last Name:WEST
Suffix:
Gender:F
Credentials:QIDP
Other - Prefix:
Other - First Name:BRIGETTE
Other - Middle Name:NICOLE
Other - Last Name:HALL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BS, MBA
Mailing Address - Street 1:23642 CROSSWORTH DR
Mailing Address - Street 2:
Mailing Address - City:NEW CANEY
Mailing Address - State:TX
Mailing Address - Zip Code:77357-1758
Mailing Address - Country:US
Mailing Address - Phone:346-313-4125
Mailing Address - Fax:
Practice Address - Street 1:23642 CROSSWORTH DR
Practice Address - Street 2:
Practice Address - City:NEW CANEY
Practice Address - State:TX
Practice Address - Zip Code:77357-1758
Practice Address - Country:US
Practice Address - Phone:346-313-4125
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-20
Last Update Date:2023-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
No174200000XOther Service ProvidersMeals
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No251B00000XAgenciesCase Management
No320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)