Provider Demographics
NPI:1598539157
Name:VANDERPOOL, BRIANNA LEE (PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:BRIANNA
Middle Name:LEE
Last Name:VANDERPOOL
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:445 WESTERN BLVD STE G
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28546-6852
Mailing Address - Country:US
Mailing Address - Phone:910-333-1323
Mailing Address - Fax:
Practice Address - Street 1:445 WESTERN BLVD STE G
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28546-6852
Practice Address - Country:US
Practice Address - Phone:910-333-1323
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-14
Last Update Date:2023-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2023151437363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health