Provider Demographics
NPI:1609572411
Name:CHUNG, BRIANNA LEE (FNP)
Entity Type:Individual
Prefix:
First Name:BRIANNA
Middle Name:LEE
Last Name:CHUNG
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8101 CLAYTON RD
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63117-1103
Mailing Address - Country:US
Mailing Address - Phone:314-726-2124
Mailing Address - Fax:
Practice Address - Street 1:8101 CLAYTON RD
Practice Address - Street 2:
Practice Address - City:CLAYTON
Practice Address - State:MO
Practice Address - Zip Code:63117-1103
Practice Address - Country:US
Practice Address - Phone:314-726-2124
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-02
Last Update Date:2023-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2023004940363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily