Provider Demographics
NPI:1528856549
Name:BRIGSTOCK, ANDREA NICOLE
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:NICOLE
Last Name:BRIGSTOCK
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 1:12401 S 569 RD
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:OK
Mailing Address - Zip Code:74354-5185
Mailing Address - Country:US
Mailing Address - Phone:620-423-4820
Mailing Address - Fax:
Practice Address - Street 1:203 2ND AVE SW
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:OK
Practice Address - Zip Code:74354-6818
Practice Address - Country:US
Practice Address - Phone:918-542-6412
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-29
Last Update Date:2025-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool