Provider Demographics
NPI:1982440160
Name:WEBB, BRENT WILLIAM ROBERT
Entity type:Individual
Prefix:
First Name:BRENT
Middle Name:WILLIAM ROBERT
Last Name:WEBB
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:80 GETTYSBURG SQUARE RD APT 74
Mailing Address - Street 2:
Mailing Address - City:FORT THOMAS
Mailing Address - State:KY
Mailing Address - Zip Code:41075-1455
Mailing Address - Country:US
Mailing Address - Phone:812-577-7218
Mailing Address - Fax:
Practice Address - Street 1:1 LOUIE B NUNN DR
Practice Address - Street 2:
Practice Address - City:HIGHLAND HEIGHTS
Practice Address - State:KY
Practice Address - Zip Code:41099-9993
Practice Address - Country:US
Practice Address - Phone:812-577-7218
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-08
Last Update Date:2024-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program