Provider Demographics
NPI:1013987320
Name:BERENS-BROWNMILLER, KATHY (PAC)
Entity type:Individual
Prefix:
First Name:KATHY
Middle Name:
Last Name:BERENS-BROWNMILLER
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 N 14TH ST
Mailing Address - Street 2:
Mailing Address - City:DENISON
Mailing Address - State:IA
Mailing Address - Zip Code:51442
Mailing Address - Country:US
Mailing Address - Phone:712-263-5071
Mailing Address - Fax:712-263-6106
Practice Address - Street 1:115 N 14TH ST
Practice Address - Street 2:
Practice Address - City:DENISON
Practice Address - State:IA
Practice Address - Zip Code:51442
Practice Address - Country:US
Practice Address - Phone:712-263-5071
Practice Address - Fax:712-263-6106
Is Sole Proprietor?:No
Enumeration Date:2006-01-26
Last Update Date:2021-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA00867363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0141002Medicaid
IA0141002Medicaid
S49092Medicare UPIN