Provider Demographics
NPI:1770857559
Name:GRENNAN, KATHLEEN (CNM, APRN)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:
Last Name:GRENNAN
Suffix:
Gender:F
Credentials:CNM, APRN
Other - Prefix:
Other - First Name:KATIE
Other - Middle Name:
Other - Last Name:GRENNAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:12240 LAMINGTON DR
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76244-7563
Mailing Address - Country:US
Mailing Address - Phone:817-789-2088
Mailing Address - Fax:
Practice Address - Street 1:622 HEMPHILL ST
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-3179
Practice Address - Country:US
Practice Address - Phone:817-878-2737
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-27
Last Update Date:2023-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX99214176B00000X
374J00000X
TX367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No176B00000XOther Service ProvidersMidwife
No374J00000XNursing Service Related ProvidersDoula