Provider Demographics
NPI:1568791630
Name:BRADY, KATHLEEN M (ARNP)
Entity Type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:M
Last Name:BRADY
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:19 OLD KINGS RD
Mailing Address - Street 2:SUITE C 106
Mailing Address - City:PALM COAST
Mailing Address - State:FL
Mailing Address - Zip Code:32137-8260
Mailing Address - Country:US
Mailing Address - Phone:386-446-4540
Mailing Address - Fax:386-447-7732
Practice Address - Street 1:19 OLD KINGS RD
Practice Address - Street 2:SUITE C 106
Practice Address - City:PALM COAST
Practice Address - State:FL
Practice Address - Zip Code:32137-8260
Practice Address - Country:US
Practice Address - Phone:386-446-4540
Practice Address - Fax:386-447-7732
Is Sole Proprietor?:No
Enumeration Date:2009-12-18
Last Update Date:2009-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9215677363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health