Provider Demographics
NPI:1780985820
Name:HESS, BRITTANY LIN
Entity type:Individual
Prefix:MRS
First Name:BRITTANY
Middle Name:LIN
Last Name:HESS
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:BRITTANY
Other - Middle Name:LIN
Other - Last Name:KINGSLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:501 E STONER AVE
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71101-4242
Mailing Address - Country:US
Mailing Address - Phone:903-248-3436
Mailing Address - Fax:903-248-3460
Practice Address - Street 1:1005 N EASTMAN RD
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75601-4231
Practice Address - Country:US
Practice Address - Phone:903-248-3436
Practice Address - Fax:903-248-3460
Is Sole Proprietor?:No
Enumeration Date:2010-11-05
Last Update Date:2010-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT81777133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist