Provider Demographics
NPI:1396413779
Name:BRANT, KATIE MARIE (CRNP-PMH-BC)
Entity Type:Individual
Prefix:
First Name:KATIE
Middle Name:MARIE
Last Name:BRANT
Suffix:
Gender:F
Credentials:CRNP-PMH-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 12
Mailing Address - Street 2:
Mailing Address - City:KEISTERVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15449-0012
Mailing Address - Country:US
Mailing Address - Phone:724-970-8554
Mailing Address - Fax:
Practice Address - Street 1:239 FOURTH AVE., SUITE 1401 #2026
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15222
Practice Address - Country:US
Practice Address - Phone:724-970-8554
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-01
Last Update Date:2021-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP024285363LP0808X
PARN638728163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health