Healthcare Provider Details

I. General information

NPI: 1619687159
Provider Name (Legal Business Name): BRITTANY LAINE DANIEL DNP, PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/23/2022
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2341 LEWISVILLE CLEMMONS RD FL 2
CLEMMONS NC
27012-8905
US

IV. Provider business mailing address

MEDICAL CENTER BLVD
WINSTON SALEM NC
27157-0001
US

V. Phone/Fax

Practice location:
  • Phone: 336-716-4039
  • Fax: 336-713-3288
Mailing address:
  • Phone: 336-716-4039
  • Fax: 336-713-3288

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberNP500021861
License Number StateDC
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number5024764
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: