Provider Demographics
NPI:1053802926
Name:WICKWARE, BRITTANY CHARLENE (CRNP)
Entity type:Individual
Prefix:
First Name:BRITTANY
Middle Name:CHARLENE
Last Name:WICKWARE
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:30417 PINYON DR
Mailing Address - Street 2:
Mailing Address - City:SPANISH FORT
Mailing Address - State:AL
Mailing Address - Zip Code:36527-8727
Mailing Address - Country:US
Mailing Address - Phone:251-233-1075
Mailing Address - Fax:
Practice Address - Street 1:28490 2ND ST STE B
Practice Address - Street 2:
Practice Address - City:DAPHNE
Practice Address - State:AL
Practice Address - Zip Code:36526-7150
Practice Address - Country:US
Practice Address - Phone:251-308-9800
Practice Address - Fax:877-413-5104
Is Sole Proprietor?:No
Enumeration Date:2018-05-25
Last Update Date:2020-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-127339363LA2100X, 363LA2200X
FLAPRN11000136363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care