Provider Demographics
NPI:1780417626
Name:WEST, BRIANNA LONDONO (PA-C)
Entity type:Individual
Prefix:
First Name:BRIANNA
Middle Name:LONDONO
Last Name:WEST
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:BRIANNA
Other - Middle Name:NORELLA
Other - Last Name:LONDONO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:614 ARNOLD DR
Mailing Address - Street 2:
Mailing Address - City:BEAUFORT
Mailing Address - State:SC
Mailing Address - Zip Code:29902-4303
Mailing Address - Country:US
Mailing Address - Phone:843-263-2141
Mailing Address - Fax:
Practice Address - Street 1:1231 RIBAUT RD
Practice Address - Street 2:
Practice Address - City:BEAUFORT
Practice Address - State:SC
Practice Address - Zip Code:29902-6147
Practice Address - Country:US
Practice Address - Phone:843-766-7103
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-26
Last Update Date:2024-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Single Specialty