Provider Demographics
NPI:1679918189
Name:SMITH, BRIANNE (NP)
Entity type:Individual
Prefix:
First Name:BRIANNE
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 11526
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35202-1526
Mailing Address - Country:US
Mailing Address - Phone:205-903-9375
Mailing Address - Fax:855-634-9302
Practice Address - Street 1:712 25TH ST N
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35203-2400
Practice Address - Country:US
Practice Address - Phone:205-407-6900
Practice Address - Fax:205-439-7248
Is Sole Proprietor?:No
Enumeration Date:2013-05-10
Last Update Date:2024-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-184044363LF0000X
GARN195010363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL304081Medicaid
AL305411Medicaid
AL302414Medicaid