Provider Demographics
NPI:1720676646
Name:BRANNAN, KELLY SUE (RN)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:SUE
Last Name:BRANNAN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4108 9TH AVE
Mailing Address - Street 2:
Mailing Address - City:PARKERSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:26101-6516
Mailing Address - Country:US
Mailing Address - Phone:304-834-2994
Mailing Address - Fax:
Practice Address - Street 1:186 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:GRANTSVILLE
Practice Address - State:WV
Practice Address - Zip Code:26147-7100
Practice Address - Country:US
Practice Address - Phone:304-354-9244
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-06
Last Update Date:2021-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV66361163WE0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WE0003XNursing Service ProvidersRegistered NurseEmergency