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General NPI Number Information
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NPI Number | 1427381623
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Entity Type | Individual
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Provider Name | BRIAN KEITH VANDENBERG ARNP
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Gender | Male
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Dates
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Enumeration Date | 09/08/2009
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Last Update Date | 10/17/2024
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Provider Practice Location Address
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Address Line | 1583 S SAINT LOUIS ST
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City | BATESVILLE
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State | AR
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Zip | 72501-7627
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Country | US
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Telephone | 870-895-2015
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Fax |
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Provider Business Mailing Address
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Address Line | 14073 STATE HIGHWAY NN
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City | KENNETT
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State | MO
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Zip | 63857-8329
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Country | US
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Telephone | 805-403-7075
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332BN1400X
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Taxonomy Name | Nursing Facility Supplies (DME)
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 139604
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License Number State | KS
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Taxonomy #3
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 5374997032
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License Number State | KS
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Taxonomy #4
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 1427381623
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License Number State | MO
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Taxonomy #5
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 226487
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License Number State | AR
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