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Individual

BRIAN KEITH VANDENBERG

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
ARNP

Contact information

Practice address
1583 S SAINT LOUIS ST, BATESVILLE, AR 72501-7627
(870) 895-2015
Mailing address
14073 STATE HIGHWAY NN, KENNETT, MO 63857-8329
(805) 403-7075

Taxonomy

Speciality
Code
Description
License number
State
332BN1400X
Nursing Facility Supplies (DME)
363L00000X
Nurse Practitioner
139604
KS
363LF0000X
Family Nurse Practitioner
1427381623
MO
363LF0000X
Family Nurse Practitioner
Primary
226487
AR
363LF0000X
Family Nurse Practitioner
5374997032
KS

Other

Enumeration date
09/08/2009
Last updated
10/17/2024
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