Provider Demographics
NPI:1598554578
Name:WALLER, BRITTNEY (FNP-C)
Entity type:Individual
Prefix:
First Name:BRITTNEY
Middle Name:
Last Name:WALLER
Suffix:
Gender:
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5925 PAINTED LEAF DR
Mailing Address - Street 2:
Mailing Address - City:NEW ALBANY
Mailing Address - State:OH
Mailing Address - Zip Code:43054-8156
Mailing Address - Country:US
Mailing Address - Phone:614-571-5729
Mailing Address - Fax:
Practice Address - Street 1:1000 HIGH ST STE B
Practice Address - Street 2:
Practice Address - City:WORTHINGTON
Practice Address - State:OH
Practice Address - Zip Code:43085-4093
Practice Address - Country:US
Practice Address - Phone:614-810-8575
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-05
Last Update Date:2025-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0038755363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily