Provider Demographics
NPI:1710373113
Name:BRENNAN, KATHLEEN (DNP)
Entity Type:Individual
Prefix:DR
First Name:KATHLEEN
Middle Name:
Last Name:BRENNAN
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 4TH ST NW
Mailing Address - Street 2:PO BOX 1088
Mailing Address - City:PULASKI
Mailing Address - State:VA
Mailing Address - Zip Code:24301
Mailing Address - Country:US
Mailing Address - Phone:540-980-0922
Mailing Address - Fax:540-980-2931
Practice Address - Street 1:25 4TH ST NW
Practice Address - Street 2:
Practice Address - City:PULASKI
Practice Address - State:VA
Practice Address - Zip Code:24301-4613
Practice Address - Country:US
Practice Address - Phone:540-980-0922
Practice Address - Fax:650-980-2931
Is Sole Proprietor?:No
Enumeration Date:2015-04-13
Last Update Date:2022-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024172498363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily