Basic Information
Provider Information | |||||||||
NPI: | 1336677699 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | CANADY | ||||||||
FirstName: | BRITTANY | ||||||||
MiddleName: |   | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | DNP, FNP | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 444 SW CENTER ST | ||||||||
Address2: | PO BOX 187 | ||||||||
City: | FASION | ||||||||
State: | NC | ||||||||
PostalCode: | 283412834 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9102670421 | ||||||||
FaxNumber: | 8557486239 | ||||||||
Practice Location | |||||||||
Address1: | 5 WHITEVILLE TOWNCENTER | ||||||||
Address2: |   | ||||||||
City: | WHITEVILLE | ||||||||
State: | NC | ||||||||
PostalCode: | 28472 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9102126613 | ||||||||
FaxNumber: | 9102678986 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 05/31/2017 | ||||||||
LastUpdateDate: | 08/16/2018 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 5009529 | NC | Y |   | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.