Provider Demographics
NPI:1780939975
Name:MCKENNA, BRENDA KAYE (CNP)
Entity type:Individual
Prefix:
First Name:BRENDA
Middle Name:KAYE
Last Name:MCKENNA
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Gender:F
Credentials:CNP
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Mailing Address - Street 1:UNM DEPARTMENT OF PSYCHIATRY AND BEHAVIORAL HEALTH SCIE
Mailing Address - Street 2:1 UNIVERSITY OF NEW MEXICO
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87131
Mailing Address - Country:US
Mailing Address - Phone:520-628-8287
Mailing Address - Fax:505-272-4921
Practice Address - Street 1:UNM DEPARTMENT OF PSYCHIATRY AND BEHAVIORAL HEALTH SCIE
Practice Address - Street 2:1 UNIVERSITY OF NEW MEXICO
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87131
Practice Address - Country:US
Practice Address - Phone:520-628-8287
Practice Address - Fax:505-272-4921
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-13
Last Update Date:2023-07-14
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Provider Licenses
StateLicense IDTaxonomies
NM03131363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM8025517Medicaid