Provider Demographics
NPI:1457980344
Name:CHAMPION, BRIANA NICOLE (NP)
Entity type:Individual
Prefix:
First Name:BRIANA
Middle Name:NICOLE
Last Name:CHAMPION
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2355 LEBANON RD APT 9305
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75034-6477
Mailing Address - Country:US
Mailing Address - Phone:972-374-7921
Mailing Address - Fax:
Practice Address - Street 1:5301 W SPRING CREEK PKWY APT 1921
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75024-4910
Practice Address - Country:US
Practice Address - Phone:972-374-7921
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-03
Last Update Date:2021-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX885218163W00000X
TX1016492363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse