Provider Demographics
NPI:1568973568
Name:LAND, BRITTANY N
Entity type:Individual
Prefix:
First Name:BRITTANY
Middle Name:N
Last Name:LAND
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:BRITTANY
Other - Middle Name:N
Other - Last Name:BARMES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1021 E POPLAR ST
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72830-4428
Mailing Address - Country:US
Mailing Address - Phone:479-754-8610
Mailing Address - Fax:479-754-8788
Practice Address - Street 1:1021 E POPLAR ST
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:AR
Practice Address - Zip Code:72830-4428
Practice Address - Country:US
Practice Address - Phone:479-754-8610
Practice Address - Fax:479-754-8788
Is Sole Proprietor?:No
Enumeration Date:2017-10-17
Last Update Date:2024-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
AR12882-M104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR223278795Medicaid