Healthcare Provider Details

I. General information

NPI: 1225703770
Provider Name (Legal Business Name): BRITTNEY LEIGH VAN LAEKEN AGACNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BRITTNEY LEIGH KENDALL

II. Dates (important events)

Enumeration Date: 08/16/2021
Last Update Date: 03/07/2023
Certification Date: 02/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 N ELM ST
HENDERSON KY
42420-2005
US

IV. Provider business mailing address

PO BOX 19599
BELFAST ME
04915-4090
US

V. Phone/Fax

Practice location:
  • Phone: 731-394-1145
  • Fax:
Mailing address:
  • Phone: 731-394-1145
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number71011790A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number3018986
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: