Provider Demographics
NPI:1184761397
Name:MACAPAGAL, KATHLEEN MARY BRENNAN (CPNP, RN, CPN, IBCLC)
Entity type:Individual
Prefix:MRS
First Name:KATHLEEN
Middle Name:MARY BRENNAN
Last Name:MACAPAGAL
Suffix:
Gender:F
Credentials:CPNP, RN, CPN, IBCLC
Other - Prefix:MS
Other - First Name:KATHLEEN
Other - Middle Name:MARY BRENNAN
Other - Last Name:MACAPAGAL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CPNP, RN, CPN, RNC
Mailing Address - Street 1:NAVAL MEDICAL CENTER PORTSMOUTH
Mailing Address - Street 2:620 JOHN PAUL JONES CIRCLE
Mailing Address - City:PORTSMOUTH
Mailing Address - State:VA
Mailing Address - Zip Code:23708
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:NAVAL MEDICAL CENTER PORTSMOUTH
Practice Address - Street 2:620 JOHN PAUL JONES CIRCLE
Practice Address - City:PORTSMOUTH
Practice Address - State:VA
Practice Address - Zip Code:23708
Practice Address - Country:US
Practice Address - Phone:757-953-5000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2021-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR200441798RN163WP0200X
OR201150024NP363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No163WP0200XNursing Service ProvidersRegistered NursePediatrics