Active NPI
Jerry Lee Brittain, PH.D.
- Clinical Psychologist
- Kernersville, NC
National Provider Identifier
1972516367
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 3897
- Practice address
- 703 E Mountain St
Kernersville, NC 27284 - Phone
- (743) 220-1484
- Fax
- (743) 220-1782
- NPI assigned
- Aug 15, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Neuropsychologist | 103G00000X | 0810001965 | VA | |
| Clinical Psychologist | 103TC0700X | 3897 | NC | Primary |
Addresses
Primary practice location
703 E Mountain St
Kernersville, NC 27284
Mailing address
703 E Mountain St
Kernersville, NC 27284
Phone (743) 220-1484
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0810001965 | Other | VA | VA LICENSE |
Other names 1
- Jerry Lee Brittain
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0810001965 | VA | MD | Clinical Neuropsychologist |
| 3897 | NC | MD | Speech-Language Pathologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| T Med Behavioral Inc | Clinical | Past | Accepting new patients |
| Psychological Mobile Services | Past | Accepting new patients | |
| New River Service Authority | Past | Accepting new patients | |
| New River Service Authority | Past | Accepting new patients |
Organizations & group practices 4
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Community/Behavioral Health Agency
- Lenoir, NC
- NPI 1659532562
-
- Foster Care Agency
- Boone, NC
- NPI 1720360944
-
- Psychologist
- Clayton, NC
- NPI 1689098774
-
- Clinical Psychologist
- Fairfax, VA
- NPI 1497719272
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1155600000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1776902400000",
"number": "1972516367",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "703 E MOUNTAIN ST",
"city": "KERNERSVILLE",
"state": "NC",
"postal_code": "27284",
"telephone_number": "743-220-1484",
"fax_number": "743-220-1782"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "703 E MOUNTAIN ST",
"city": "KERNERSVILLE",
"state": "NC",
"postal_code": "27284",
"telephone_number": "743-220-1484",
"fax_number": "743-220-1782"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BRITTAIN",
"first_name": "JERRY",
"middle_name": "LEE",
"credential": "PH.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-08-15",
"last_updated": "2026-04-23",
"certification_date": "2026-04-23",
"status": "A"
},
"taxonomies": [
{
"code": "103G00000X",
"taxonomy_group": "",
"desc": "Clinical Neuropsychologist",
"state": "VA",
"license": "0810001965",
"primary": false
},
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "NC",
"license": "3897",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "VA LICENSE",
"identifier": "0810001965",
"state": "VA"
}
],
"endpoints": [],
"other_names": [
{
"first_name": "JERRY",
"last_name": "BRITTAIN",
"middle_name": "LEE",
"credential": "PH.D.",
"code": "2",
"type": "Professional Name"
}
]
}Other providers in Kernersville, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 23, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.