Basic Information
Provider Information
NPI: 1073957163
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: CALICO
FirstName: BRITTANY
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: D.O.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName: HALE
OtherFirstName: BRITTANY
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType: 1
Mailing Information
Address1: PO BOX 635283
Address2:  
City: CINCINNATI
State: OH
PostalCode: 452635283
CountryCode: US
TelephoneNumber: 8599127211
FaxNumber: 8596558981
Practice Location
Address1: 1500 JAMES SIMPSON JR WAY
Address2:  
City: COVINGTON
State: KY
PostalCode: 41011
CountryCode: US
TelephoneNumber: 8599127211
FaxNumber: 8596558981
Other Information
ProviderEnumerationDate: 04/19/2013
LastUpdateDate: 09/04/2018
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207QG0300X04209KYY Allopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
390200000X TXN Student, Health CareStudent in an Organized Health Care Education/Training Program 

No ID Information.


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