Active NPI
Brittany Sue Waggoner, CLC
- Lactation Consultant (Non-RN)
- McEwen, TN
National Provider Identifier
1104591734
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Lactation Consultant (Non-RN)
- License
- 332098
- Practice address
- 3770 E. Blue Creek Rd
McEwen, TN 37101 - Phone
- (931) 209-7610
- Fax
- (931) 444-5850
- NPI assigned
- Aug 16, 2021
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Lactation Consultant (Non-RN) | 174N00000X | 332098 | MA | Primary |
Addresses
Primary practice location
3770 E. Blue Creek Rd
McEwen, TN 37101
Mailing address
3770 E. Blue Creek Rd
McEwen, TN 37101
Phone (931) 209-7610
Other names 1
- Miss Brittany Wells
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 332098 | MA | MD | Lactation Consultant (Non-RN) |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1629072000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1629072000000",
"number": "1104591734",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3770 E. BLUE CREEK RD",
"city": "MCEWEN",
"state": "TN",
"postal_code": "37101",
"telephone_number": "931-209-7610",
"fax_number": "931-444-5850"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3770 E. BLUE CREEK RD",
"city": "MCEWEN",
"state": "TN",
"postal_code": "37101",
"telephone_number": "931-209-7610",
"fax_number": "931-444-5850"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WAGGONER",
"first_name": "BRITTANY",
"middle_name": "SUE",
"name_prefix": "Mrs.",
"credential": "CLC",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2021-08-16",
"last_updated": "2021-08-16",
"certification_date": "2021-07-21",
"status": "A"
},
"taxonomies": [
{
"code": "174N00000X",
"taxonomy_group": "",
"desc": "Lactation Consultant, Non-RN",
"state": "MA",
"license": "332098",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "BRITTANY",
"last_name": "WELLS",
"prefix": "MISS",
"code": "1",
"type": "Former Name"
}
]
}Other providers in McEwen, TN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 16, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.