Provider Demographics
NPI:1982474599
Name:MCKELVEY, BRENNA LYNN (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:BRENNA
Middle Name:LYNN
Last Name:MCKELVEY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MISS
Other - First Name:BRENNA
Other - Middle Name:LYNN
Other - Last Name:OLSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1700 HIGHWAY 25 N
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:MN
Mailing Address - Zip Code:55313-1930
Mailing Address - Country:US
Mailing Address - Phone:763-682-1313
Mailing Address - Fax:763-581-9090
Practice Address - Street 1:1700 HIGHWAY 25 N
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:MN
Practice Address - Zip Code:55313-1930
Practice Address - Country:US
Practice Address - Phone:763-682-1313
Practice Address - Fax:763-581-9090
Is Sole Proprietor?:No
Enumeration Date:2024-01-04
Last Update Date:2024-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant